Complex Lower Genitourinary Fistula Repair: Rectourethral Fistula and Puboprostatic Fistula

Rectourethral fistula (RUF) and puboprostatic fistula (PPF) are potentially devastating complications that can develop after various pelvic insults, most notable treatment of prostate cancer. Both entities represent surgical challenges given the complex anatomy, risk of injury to adjacent structures, and poor tissue quality and wound healing. While extirpative surgery may be necessary for some patients, meticulous surgical dissection and interposition of healthy muscle allow for fistula repair in a high proportion of appropriately selected patients, especially in RUF. Herein the authors describe the nature, management, and outcomes of RUF and PPF with a full review of the literature.