A systematic review on the surgical management of acquired rectourethral fistula

Recto-urethral fistulas represent a rare and challenging condition, occurring either congenitally or due to various prostatic and pelvic interventions such as radical prostatectomy and radiation therapies. This condition often manifests with symptoms such as pneumaturia, fecaluria, and urinary tract infections. Despite its rarity, this condition presents significant clinical management challenges due to the lack of consensus on standardized treatment protocols, particularly in patients with a history of irradiation. This study aims to systematically review the available literature on the efficacy and safety of primary surgical repair of adult-acquired recto-urethral fistulas. We conducted a comprehensive bibliographic search of MEDLINE, Scopus, and Web of Science Core Collection databases in August 2024, following the PRISMA guidelines. A total of 10 studies, covering over 500 patients, were included in our review. The most common surgical approach used was the transperineal technique with gracilis muscle flap interposition. Findings indicate higher complication rates and diminished healing in irradiated patients compared to non-irradiated counterparts. Although transperineal approaches generally resulted in high success rates irradiated individuals frequently required additional surgeries or definitive urinary diversion. Further research is required to establish evidence-based guidelines for optimal management, particularly for complex cases involving radiation-induced recto-urethral fistulas.