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Rectourethral Fistula Treatment

Rectourethral fistula is an abnormal connection between the rectum and urethra causing passage of urine into the rectum and fecal contamination of the urinary tract. Pristyn Care offers expert minimally invasive surgical repair with high success rates.

Rectourethral fistula is an abnormal connection between the rectum and urethra causing passage ... Read More

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    Dr. Galla Murali Mohan - A general-surgeon for Anal Fistula

    Dr. Galla Murali Mohan

    MBBS, MS-General Surgery
    34 Yrs.Exp.

    5.0/5

    34 Years Experience

    location icon Pristyn Care Archana Hospital, Madeenaguda, Hyderabad
    Call Us
    080-6542-3724
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    Dr. Vipin Nagpal - A general-surgeon for Anal Fistula

    Dr. Vipin Nagpal

    MBBS, MS-General Surgery
    31 Yrs.Exp.

    5.0/5

    31 Years Experience

    location icon Pristyn Care Elantis Hospital, Lajpat Nagar, Delhi
    Call Us
    080-6542-3711
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    Dr. Rakesh Shivhare - A general-surgeon for Anal Fistula

    Dr. Rakesh Shivhare

    MBBS, MS(GI & General Surgeon)
    30 Yrs.Exp.

    5.0/5

    30 Years Experience

    location icon Opp.Badwani Plaza, Manorama Ganj, Old Palasia, Indore, Madhya Pradesh 452003
    Call Us
    080-6542-3720
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    Dr. Apoorv Shrivastava - A general-surgeon for Anal Fistula

    Dr. Apoorv Shrivastava

    MBBS, DNB-General Surgery
    25 Yrs.Exp.

    4.5/5

    25 Years Experience

    location icon Pristyn Care Eminent Hospital 6/1 Opp. Barwani Plaza, Manorama Ganj, Old Palasia, Indore - 452018
    Call Us
    080-6542-3720

What is Rectourethral Fistula?

Rectourethral fistula (RUF) is an abnormal communication between the rectum and urethra, allowing urine to pass into the rectum and stool or gas to enter the urinary tract. It commonly occurs after prostate surgery, radiation therapy, trauma, or infection. This condition can significantly affect quality of life and requires specialised surgical management. Pristyn Care provides advanced minimally invasive and sphincter-preserving treatment options with excellent outcomes.

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Symptoms

Symptoms of Rectourethral Fistula include:

  • Passage of urine through the rectum
  • Fecal matter in urine (fecaluria)
  • Air bubbles in urine (pneumaturia)
  • Recurrent urinary tract infections
  • Pain or discomfort in the perineal region
  • Difficulty in urination
  • Fever in case of infection

Are you going through any of these symptoms?

Causes

Rectourethral fistula can be caused by:

  • Prostate surgery (most common cause)
  • Radiation therapy for prostate or rectal cancer
  • Pelvic trauma or injury
  • Infections or abscess formation
  • Inflammatory bowel disease
  • Iatrogenic injury during pelvic procedures

Types of Rectourethral Fistula

Classified based on complexity:

  • Simple RUF — small, non-radiated, and without infection
  • Complex RUF — large, recurrent, or associated with radiation or infection
  • Post-surgical RUF — following prostatectomy or pelvic surgery
  • Radiation-induced RUF — due to tissue damage from radiation therapy

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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

Frequently Asked Questions

What is Rectourethral Fistula?

Rectourethral fistula is an abnormal connection between the rectum and the urethra, allowing urine to pass into the rectum and stool or gas to enter the urinary tract. This can lead to symptoms like passage of urine through the rectum, recurrent urinary infections, and discomfort.

Can Rectourethral Fistula heal on its own?

In very rare and small cases, especially after minor injury or surgery, a rectourethral fistula may improve with conservative management such as catheterization, antibiotics, and proper nutrition. However, most cases do not heal on their own and require surgical treatment for complete closure.

What is the best treatment for Rectourethral Fistula?

Minimally invasive surgical repair is considered the most effective treatment. Techniques such as transperineal repair with tissue interposition (like gracilis muscle flap) are commonly used. The choice of procedure depends on the size, location, and cause of the fistula.

How long is recovery after Rectourethral Fistula repair

Recovery typically takes around 4–6 weeks for initial healing. A urinary catheter may be required for a few weeks to allow proper healing. In complex cases, or if a temporary diversion (colostomy) is needed, full recovery may take a few months.

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Medically Reviewed By
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Dr. Galla Murali Mohan
MBBS, MS-General Surgery
34 Years Experience Overall
Last Updated : April 29, 2026

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