Urethrorectal fistula: transanal, transsphincteric approach with locally based pedicle interposition flaps

We report preliminary experience with the transsphincteric, transanal surgical approach to correct acquired urethrorectal fistula.

Five men with an acquired urethrorectal fistula underwent surgical correction. Mean patient age was 56.6 years (range 37 to 72). The etiology was surgical (radical prostatectomy) in 3 cases, traumatic in 1 and idiopathic in 1. All 5 patients had urinary tract infection and pneumaturia, and 3 (60%) had watery stool. Conservative treatments had failed in all cases. The time from the diagnosis of urethrorectal fistula to surgery was 4 weeks to 4 years. RESULTSFive men underwent excision and closure of a urethrorectal fistula with diverting colostomy. In 4 men (80%) urinary continence subsequently returned with adequate sphincter tone, while in 1 (20%) with perineal trauma and active proctitis the fistula recurred 6 weeks after surgery.

Urethrorectal fistulas are rare and surgically challenging. The transsphincteric, transanal surgical approach provides many advantages, including easy access and identification of the fistula tract, good surgical exposure, adequate resection to well vascularized tissue and access to several vascularized flaps for interposition between the repaired urinary and gastrointestinal tracts.