Surgical management of rectourethral fistula in different situations

This study was done to see the outcome of repair of rectourethral fistula (RUF) in different situations between 2002 and 2009 in Chittagong and Dhaka Medical College Hospitals. We prospectively reviewed the records of all the patients who developed rectourethral fistula. Total 18 patients were included and in all cases faecal and urinary diversion was done preoperatively. In 4 patients fistulas size was <1cm where spontaneous closure of RUF occured after 6 months of diversion. In 8 patients repair of fistula was done through the perineal approach where excision of fistulas tract with anastomotic urethroplasty and repair of rectal wound was done. Out of these 8 patients tunica vaginalis flap was applied in 3 and dartos pedicle flap in 5 cases, in the remaining 6 patients transrectal York-Mason repair was done. Out of 6 patients of York-Mason repair, one developed recurrent fistula - which underwent repair with a graft through the perineal approach later on with good result. No patient developed urinary or faecal incontinence. In 2 patients leakage of urine was noted in post operative days in the perineal wound and catheter was kept for 3 weeks more. No one had erectile dysfunction. Both faecal & urinary diversion adds benefit to the outcome of the rectourethral fistula. Transrectal York-Mason repair is easier to do with less morbidity and complication while perineal approach with graft interposition may be done in cases where anastomotic urethroplasty is needed along with fistula repair.