Skip to main content

Rectourethral and Colovesical Fistula

  • Chapter
  • First Online:
Techniques of Robotic Urinary Tract Reconstruction

Abstract

Rectourethral fistula (RUF) is a devastating complication of prostatic cancer therapy or may result from a host of other conditions. RUF not only poses a medical and surgical challenge in and of itself, but its management is further complicated due to the lack of robust evidence to guide treatment. The sum of the listed issues makes the condition a challenge for the practicing urologist. The first step is to devise a standardized staging system, which may aid in developing higher level evidence to guide further management. This chapter offers a broad perspective on the etiology, workup, and management of the condition, with the aim to provide the practitioner with a sufficient knowledge to build upon.

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

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

RUF:

Rectourethral fistula

XRT/AB:

Radiation and ablative therapy

EBRT:

External beam radiation therapy

HIFU:

High-intensity focused ultrasound

RUG:

Retrograde urethrogram

References

  1. Choi JH, Jeon BG, Choi S-G, Han EC, Ha H-K, Oh H-K, et al. Rectourethral fistula: systemic review of and experiences with various surgical treatment methods. Ann Coloproctol. 2014;30(1):35–41.

    Article  Google Scholar 

  2. Chen S, Gao R, Li H, Wang K. Management of acquired rectourethral fistulas in adults. Asian J Urol. 2018;5(3):149–54.

    Article  Google Scholar 

  3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30.

    Article  Google Scholar 

  4. Thomas C, Jones J, Jäger W, Hampel C, Thüroff JW, Gillitzer R. Incidence, clinical symptoms and management of rectourethral fistulas after radical prostatectomy. J Urol. 2010;183(2):608–12.

    Article  Google Scholar 

  5. Wedmid A, Mendoza P, Sharma S, Hastings RL, Monahan KP, Walicki M, et al. Rectal injury during robot-assisted radical prostatectomy: incidence and management. J Urol. 2011;186(5):1928–33.

    Article  Google Scholar 

  6. Lance RS, Freidrichs PA, Kane C, Powell CR, Pulos E, Moul JW, et al. A comparison of radical retropubic with perineal prostatectomy for localized prostate cancer within the uniformed services urology research group. BJU Int. 2001;87(1):61–5.

    Article  CAS  Google Scholar 

  7. Faris SF, Milam DF, Dmochowski RR, Kaufman MR. Urinary diversions after radiation for prostate cancer: indications and treatment. Urology. 2014;84(3):702–6.

    Article  Google Scholar 

  8. Zinman L. The management of the complex recto-urethral fistula – Zinman – 2004 – BJU International – Wiley Online Library [Internet]. 2004. [cited 2020 Jan 18]. Available from: https://onlinelibrary-wiley-com.ezproxy.med.nyu.edu/doi/epdf/10.1111/j.1464-410X.2004.05225.x

  9. Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG clinical guideline: management of crohnʼs disease in adults. Am J Gastroenterol. 2018;113(4):481–517.

    Article  Google Scholar 

  10. Harris CR, McAninch JW, Mundy AR, Zinman LN, Jordan GH, Andrich D, et al. Rectourethral fistulas secondary to prostate cancer treatment: management and outcomes from a multi-institutional combined experience. J Urol. 2017;197(1):191–4.

    Article  Google Scholar 

  11. Evans LA, Ferguson KH, Foley JP, Rozanski TA, Morey AF. Fibrin sealant for the management of genitourinary injuries, fistulas and surgical complications. J Urol. 2003;169(4):1360–2.

    Article  CAS  Google Scholar 

  12. Nicita G, Villari D, Caroassai Grisanti S, Marzocco M, Li Marzi V, Martini A. Minimally invasive transanal repair of rectourethral fistulas. Eur Urol. 2017;71(1):133–8.

    Article  Google Scholar 

  13. Martini A, Gandaglia G, Nicita G, Montorsi F. A novel classification proposal for rectourethral fistulas after primary treatment of prostate cancer. Eur Urol Oncol. 2018;1(6):510–1.

    Article  Google Scholar 

  14. Golabek T, Szymanska A, Szopinski T, Bukowczan J, Furmanek M, Powroznik J, et al. Enterovesical fistulae: aetiology, imaging, and management. Gastroenterol Res Pract [Internet]. 2013 [cited 2020 Feb 29];2013. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3857900/

  15. Munoz MMD, Nelson HMD, Harrington JMD, Tsiotos GMD, Devine RMD, Engen DMD. Management of acquired rectourinary fistulas: outcome according to cause. Dis Colon Rectum. 1998;41(10):1230–8.

    Article  CAS  Google Scholar 

  16. Scozzari G, Arezzo A, Morino M. Enterovesical fistulas: diagnosis and management. Tech Coloproctol. 2010;14(4):293–300.

    Article  CAS  Google Scholar 

  17. Mandel P, Linnemannstöns A, Chun F, Schlomm T, Pompe R, Budäus L, et al. Incidence, risk factors, management, and complications of rectal injuries during radical prostatectomy. Eur Urol Focus. 2018;4(4):554–7.

    Article  Google Scholar 

  18. Keller DS, Aboseif SR, Lesser T, Abbass MA, Tsay AT, Abbas MA. Algorithm-based multidisciplinary treatment approach for rectourethral fistula. Int J Color Dis. 2015;30(5):631–8.

    Article  Google Scholar 

  19. Venkatesan K, Zacharakis E, Andrich DE, Mundy AR. Conservative management of urorectal fistulae. Urology. 2013;81(6):1352–6.

    Article  Google Scholar 

  20. Bukowski TP, Chakrabarty A, Powell IJ, Frontera R, Perlmutter AD, Montie JE. Acquired rectourethral fistula: methods of repair. J Urol. 1995;153(3):730–3.

    Article  CAS  Google Scholar 

  21. Shin PR, Foley E, Steers WD. Surgical management of rectourinary fistulae11No competing interests declared. J Am Coll Surg. 2000;191(5):547–53.

    Article  CAS  Google Scholar 

  22. Davis JW, Schellhammer PF. Prostatorectal fistula 14 years following brachytherapy for prostate cancer. J Urol. 2001;165(1):189.

    Article  CAS  Google Scholar 

  23. Samplaski MK, Wood HM, Lane BR, Remzi FH, Lucas A, Angermeier KW. Functional and quality-of-life outcomes in patients undergoing transperineal repair with gracilis muscle interposition for complex rectourethral fistula. Urology. 2011;77(3):736–41.

    Article  Google Scholar 

  24. Hechenbleikner EM, Buckley JC, Wick EC. Acquired rectourethral fistulas in adults: a systematic review of surgical repair techniques and outcomes. Dis Colon Rectum. 2013;56(3):374–83.

    Article  Google Scholar 

  25. Voelzke BB, McAninch JW, Breyer BN, Glass AS, Garcia-Aguilar J. Transperineal management for postoperative and radiation rectourethral fistulas. J Urol. 2013;189(3):966–71.

    Article  Google Scholar 

  26. Renschler TD, Middleton RG. 30 years of experience with york-mason repair of recto-urinary fistulas. J Urol. 2003;170(4, Part 1):1222–5.

    Article  Google Scholar 

  27. Lane BR, Stein DE, Remzi FH, Strong SA, Fazio VW, Angermeier KW. Management of radiotherapy induced rectourethral fistula. J Urol. 2006;175(4):1382–8.

    Article  Google Scholar 

  28. Kaufman DA, Zinman LN, Buckley JC, Marcello P, Browne BM, Vanni AJ. Short- and long-term complications and outcomes of radiation and surgically induced rectourethral fistula repair with buccal mucosa graft and muscle interposition flap. Urology. 2016;98:170–5.

    Article  Google Scholar 

  29. Nikolavsky D, Blakely SA, Hadley DA, Knoll P, Windsperger AP, Terlecki RP, et al. Open reconstruction of recurrent vesicourethral anastomotic stricture after radical prostatectomy. Int Urol Nephrol. 2014;46(11):2147–52.

    Article  Google Scholar 

  30. Martins FE, Martins NM, Pinheiro LC, Ferraz L, Xambre L, Lopes TM. Management of iatrogenic urorectal fistulae in men with pelvic cancer. Can Urol Assoc J. 2017;11(9):E372–8.

    Article  Google Scholar 

  31. Netsch C, Bach T, Gross E, Gross AJ. Rectourethral fistula after high-intensity focused ultrasound therapy for prostate cancer and its surgical management. Urology. 2011;77(4):999–1004.

    Article  Google Scholar 

  32. Badenoch AW. A pull-through operation for impassable traumatic stricture of the urethra. Br J Urol. 1950;22(4):404–9.

    Article  CAS  Google Scholar 

  33. Simonato A, Gregori A, Lissiani A, Varca V, Carmignani G. Use of Solovov–Badenoch principle in treating severe and recurrent vesico-urethral anastomosis stricture after radical retropubic prostatectomy: technique and long-term results. BJU Int. 2012;110(11b):E456–60.

    Article  Google Scholar 

  34. McKibben MJ, Shakir N, Fuchs JS, Scott JM, Morey AF. Erosion rates of 3.5-cm artificial urinary sphincter cuffs are similar to larger cuffs. BJU Int. 2019;123(2):335–41.

    Article  Google Scholar 

  35. Zmora O, Potenti FM, Wexner SD, Pikarsky AJ, Efron JE, Nogueras JJ, et al. Gracilis muscle transposition for iatrogenic rectourethral fistula. Ann Surg. 2003;237(4):483–7.

    PubMed  PubMed Central  Google Scholar 

  36. Robotic TAMIS for local repair of acquired rectovaginal and rectourethral fistulae [Internet]. [cited 2020 Feb 29]. Available from: https://www.youtube.com/watch?v=eIsrFVE8TBI

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lee C. Zhao .

Editor information

Editors and Affiliations

Electronic Supplementary Material

Robotic repair of congenital rectourethral fistula

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Mishra, K., Jan, M.S., Zhao, L.C. (2022). Rectourethral and Colovesical Fistula. In: Stifelman, M.D., Zhao, L.C., Eun, D.D., Koh, C.J. (eds) Techniques of Robotic Urinary Tract Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-030-50196-9_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-50196-9_28

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-50195-2

  • Online ISBN: 978-3-030-50196-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics