Rectourethral Fistula Treatment

Risk Factors

Risk factors for Rectourethral Fistula:

• History of prostate surgery
• Pelvic radiation therapy
• Pelvic trauma or injury
• Inflammatory bowel disease
• Previous pelvic surgeries
• Chronic infections or abscesses

Who is at Risk?

Rectourethral fistula primarily affects men, especially those who have undergone prostate surgery or radiation therapy. Patients with pelvic trauma, inflammatory bowel disease, or prior pelvic procedures are also at higher risk.

Diagnosis

Diagnosis of Rectourethral Fistula involves:

• Digital rectal examination
• Cystoscopy to visualize the urethral opening
• MRI pelvis — best for complex fistulas
• Voiding cystourethrogram (VCUG)
• CT scan for associated complications
• Examination under anaesthesia (EUA)

Treatment for Rectourethral Fistula

Treatment depends on the size, cause, and severity of the fistula. Small and early fistulas may be managed with catheterization and antibiotics. However, most cases require surgical repair using minimally invasive or open techniques. Complex cases may require staged procedures with temporary colostomy or urinary diversion for proper healing.

Transperineal Repair with Muscle Flap

Transperineal repair with gracilis muscle flap for RUF:

• Performed under general anaesthesia
• Perineal incision is made to access the fistula
• Fistula tract is identified and removed
• Urethral and rectal defects are closed separately
• Gracilis muscle flap is placed between the repair sites
• Improves healing and reduces recurrence risk
• Preferred for complex or recurrent fistulas

After the Surgery

Post-operative care after RUF repair:

• Urinary catheter for 2–3 weeks to allow healing
• Low-residue diet initially
• Antibiotics and pain management
• Proper wound care and hygiene
• Avoid heavy lifting and straining
• Follow-up imaging to confirm fistula closure

Complications | Rectourethral Fistula Surgery

Potential complications of RUF repair:

• Recurrence of fistula
• Urinary incontinence
• Infection or abscess formation
• Delayed wound healing
• Urethral stricture formation
• Need for additional surgical procedures