Laparoscopic repair of acquired rectourethral fistula by vesical peritoneal flap

A rectourethral fistula (RUF) is an infrequent complication that can be iatrogenic in most cases. Multiple surgical interventions were described for RUF repair including transsphincteric, transanal, transperineal, and transabdominal approaches. To this day, there is no consensus on a standardized surgery of choice for acquired RUF.

Our patient was diagnosed with RUF 4 weeks after undergoing laparoscopic low anterior resection for midrectum adenocarcinoma, with failure of conservative treatment. A three-port transabdominal approach was used to dissect the rectoprostatic space and close the fistula orifice on the anterior rectal wall. With the technical impossibility to develop an omental flap, the peritoneum on the posterior vesical wall was carefully dissected to form a rectangular flap pedicled by its inferior aspect. The harvested peritoneal flap was then anchored between the prostate and the rectum. Follow-up imaging showed the absence of RUF, concurrently with total remission of RUF symptomatology.

Management of acquired RUF can be challenging, especially after failure of conservative treatment. Laparoscopic repair of acquired RUF by vesical peritoneal flap is a valid option for a minimally invasive approach for the treatment of RUF.