Urethrorectal Fistulas

Introduction & Urethrorectal fistula (URF) is a rare occurrence, usually following surgery or another intervention for prostatic disease, penetrating trauma, pelvic fracture and inflammatory bowel disease. Spontaneous closure is rarely successful and reconstructive procedures are usually performed. We reviewed retrospectively the medical records of 8 patients who underwent URF repair between March1995 and September 2005. Fistulaes were repaired in 3 patients due to penetrating trauma (gun shot injury, perineal surgery for bladder stone) using York Mason, in 3 patients due to pelvic fracture urethral distraction defeat using Transabdominal Transpubic with omental flap and in 2 patients due to pelvic radiation, using Transperineal with gracilis flap techniques. Diverting colostomy was performed before reconstructive surgery. One patient had failed transanal fistula repair before admission to our center, and the other 7 patients had undergone long term unsuccessful conservative management. Overall, 5 of 8 patients with URF were repaired successfully using the York Mason and Transperineal with gracilis flap techniques. Three patients with URF who underwent Transabdominal Transpubic with omental flap repair had urethral stricture and recurrence of fistula. They were managed by stage urethroplasty and a perineal skin flap was placed on the fistula. After the completion of reconstructive surgery, none of patients had urinary or fecal incontinence, but 3 patients who were repaired by Transabominal Transpubic approach were suffering from erectile dysfunction. York Mason technique has excellent results for URF with low morbidity, specially for small iatrogenic fistula with healthy margin and without scar or infection. In large fistulas due to previous radiotherapy with in appropriate tissue transperineal repair with gracilis interposition has good results.