Skip to main content

Advertisement

SpringerLink
Log in

Rectal Advancement Flap Repair of Rectourethral Fistula

A 20-Year Experience

  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: Several procedures have been described for the management of rectourethral fistula. There has been no consensus on the best method of repair. The aim of this study was to review our experience with treatment of rectourethral fistula, focusing on the outcomes of rectal advancement flap repair. METHODS: Data collected included demographics, cause, procedure type, presentation, operative details, and morbidity. Telephone follow-up was conducted to evaluate functional outcome and quality of life. RESULTS: From 1981 to 2001, 23 male patients (age, 54 ± 15 years) were treated for rectourethral fistula. Fecal diversion alone was performed in seven patients (30 percent), and urinary diversion alone was performed in one patient (4 percent). Both fecal and urinary diversion were performed in 12 patients (52 percent), and no diversion was performed in 3 (13 percent). Four patients were managed conservatively with diversion only. Nineteen patients underwent definitive repair. Rectal advancement flap repair was used in 12 (52 percent) of the cases. Postoperative length of stay was 4.5 ± 4 days. Patients were followed up for an average of 31 ± 33.4 months. Rectal advancement flap achieved primary closure in 8 (67 percent) of 12 patients. There were four recurrences. Two patients underwent successful repeat repair, for a final success rate of 83 percent. Morbidity associated with rectal advancement flap was 8 percent (1/12 patients). Cleveland Global Quality of Life score averaged 0.82 ± 0.13. CONCLUSION: The rectal advancement flap provides an effective repair for rectourethral fistula. Successful repair can be achieved in a majority of patients with minimal morbidity, short length of stay, and a good postoperative quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. M Al-Ali D Kashmoula IJ Saoud (1997) ArticleTitleExperience with 30 posttraumatic rectourethral fistulas J Urol 158 421–424

    Google Scholar 

  2. JS Thompson DE Engen RW Beart SuffixJr CE Culp (1982) ArticleTitleThe management of acquired rectourinary fistula Dis Colon Rectum 25 689–692

    Google Scholar 

  3. LE Harpster FM Rommel PR Sieber et al. (1995) ArticleTitleThe incidence and management of rectal injury associated with radical prostatectomy in a community based urology practice J Urol 154 1435–1438

    Google Scholar 

  4. N Green H Goldberg H Goldman L Lombardo L Skaist (1984) ArticleTitleSevere rectal injury following radiation for prostatic cancer J Urol 131 701–704

    Google Scholar 

  5. JK Kyle (1980) ArticleTitleUrinary complications of Crohn’s disease World J Surg 4 153–159

    Google Scholar 

  6. JS Stamler JJ Bauer HD Janowitz (1985) ArticleTitleRectourethroperineal fistula in Crohn’s disease Am J Gastroenterol 80 111–112

    Google Scholar 

  7. WE Goodwin RD Turner CC Winter (1958) ArticleTitleRectourinary fistula J Urol 80 246–254

    Google Scholar 

  8. FR Kilpatrick AY Mason (1969) ArticleTitlePost-operative recto-prostatic fistula Br J Urol 41 649–654

    Google Scholar 

  9. AG Parks RW Motson (1983) ArticleTitlePeranal repair of rectoprostatic fistula Br J Surg 70 725–726

    Google Scholar 

  10. JA Ryan HG Beebe RP Gibbons (1979) ArticleTitleGracilis muscle flap for closure of rectourethral fistula J Urol 122 124–125

    Google Scholar 

  11. A Trippitelli G Barbagli R Lenzi C Fiorelli GC Masini (1985) ArticleTitleSurgical treatment of rectourethral fistulae Eur Urol 11 388–391

    Google Scholar 

  12. DK Wilbert G Buess KH Bichler (1996) ArticleTitleCombined endoscopic closure of rectourethral fistula J Urol 155 256–258

    Google Scholar 

  13. HW Bauer W Sturm E Schmiedt (1984) ArticleTitleSurgical correction of rectoprostatic fistula Urology 24 452–455

    Google Scholar 

  14. RP Boushey RS McLeod Z Cohen (1998) ArticleTitleSurgical management of acquired rectourethral fistula, emphasizing the posterior approach Can J Surg 41 241–244

    Google Scholar 

  15. OS Culp HW Calhoon (1964) ArticleTitleA variety of rectourethral fistulas J Urol 91 560–571

    Google Scholar 

  16. DS Dahl PM Howard RG Middleton (1974) ArticleTitleThe surgical management of rectourinary fistulas resulting from a prostatic operation J Urol 111 514–517

    Google Scholar 

  17. WR Johnson DM Druitt JP Masterson (1981) ArticleTitleAnterior rectal advancement flap in the repair of benign rectoprostatic fistula Aust N Z J Surg 51 383–385

    Google Scholar 

  18. ML Prasad R Nelson E Hambrick H Abcarian (1983) ArticleTitleYork Mason procedure for repair of postoperative rectoprostatic urethral fistula Dis Colon Rectum 26 716–720

    Google Scholar 

  19. RC Tiptaft RW Motson AJ Costello AM Paris JP Blandy (1983) ArticleTitleFistulae involving rectum and urethra Br J Surg 55 711–715

    Google Scholar 

  20. J Vidal Sans J Palou Redorta J Pradell Teigell JM Banus Gassol (1985) ArticleTitleManagement and treatment of eighteen rectourethral fistulas Eur Urol 11 300–305

    Google Scholar 

  21. DD Venable (1989) ArticleTitleModification of the anterior perineal transanorectal approach for complicated prostatic urethrorectal fistula repair J Urol 142 381–384

    Google Scholar 

  22. TW Wood RG Middleton (1990) ArticleTitleSingle-stage transrectal transsphincteric (modified York-Mason) repair of rectourinary fistulas Urology 35 27–30

    Google Scholar 

  24. IM Thompson AC Marx (1990) ArticleTitleConservative therapy of rectourethral fistula Urology 35 533–536

    Google Scholar 

  25. VW Fazio IT Jones DG Jagelman FL Weakley (1987) ArticleTitleRectourethral fistulas in Crohn’s disease Surg Gynecol Obstet 164 148–150

    Google Scholar 

  26. IT Jones VW Fazio DG Jagelman (1987) ArticleTitleThe use of transanal rectal advancement flaps in the management of fistulas involving the anorectum Dis Colon Rectum 30 919–923

    Google Scholar 

  27. PM Marchesa TL Hull VW Fazio (1998) ArticleTitleAdvancement sleeve flaps for treatment of severe perianal Crohn’s disease Br J Surg 85 1695–1698

    Google Scholar 

  28. N Hyman (1999) ArticleTitleEndoanal advancement flap repair for complex anorectal fistulas Am J Surg 178 337–340

    Google Scholar 

  29. F Makowiec EC Jehle HD Becker M Starlinger (1995) ArticleTitleClinical course after transanal advancement flap repair of perianal fistula in patients with Crohn’s disease Br J Surg 82 603–606

    Google Scholar 

  30. VW Fazio MG O’Riordan IC Lavery et al. (1999) ArticleTitleLong-term functional outcome and quality of life after stapled restorative proctocolectomy Ann Surg 230 575–586

    Google Scholar 

  31. J Ruis A Nessim JJ Nogueras SD Wexner (2000) ArticleTitleGracilis transposition in complicated perianal fistula and unhealed perineal wounds in Crohn’s disease Eur J Surg 166 218–222

    Google Scholar 

  32. DC Nyam JH Pemberton (1999) ArticleTitleManagement of iatrogenic rectourethral fistula Dis Colon Rectum 42 994–999

    Google Scholar 

  33. WG Robertson JS Mangione (1998) ArticleTitleCutaneous advancement flap closure Dis Colon Rectum 41 884–887

    Google Scholar 

  34. TP Bukowski A Chakrabarty IJ Powell R Frontera AD Perlmutter JE Montie (1995) ArticleTitleAcquired rectourethral fistula J Urol 153 730–737

    Google Scholar 

Download references

Author information

Authors and Affiliations

    Authors
    1. Thomas E. Garofalo M.D.
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Conor P. Delaney M.Ch., Ph.D.
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Sandra M. Jones M.D.
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Feza H. Remzi M.D.
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Victor W. Fazio M.B., M.S.
      View author publications

      You can also search for this author in PubMed Google Scholar

    About this article

    Cite this article

    Garofalo, T.E., Delaney, C.P., Jones, S.M. et al. Rectal Advancement Flap Repair of Rectourethral Fistula. Dis Colon Rectum 46, 762–769 (2003). https://doi.org/10.1007/s10350-004-6654-6

    Download citation

    • Issue Date:

    • DOI: https://doi.org/10.1007/s10350-004-6654-6

    Keywords

    Search

    Navigation