Detailed resources and procedural information.
A rectourethral fistula is an abnormal connection between the urinary tract and the rectum. It most commonly develops after pelvic surgery, radiation therapy, pelvic trauma, or other complex procedures in the pelvis.
These fistulas can be particularly difficult to repair because the tissues are often scarred, inflamed, or affected by prior radiation. Successful treatment requires careful separation of the rectum and urinary tract, repair of each structure, and, when appropriate, placement of healthy tissue between them to promote healing and reduce the risk of recurrence.
Treatment begins with a thorough evaluation of your fistula and the surrounding tissues. This includes reviewing your prior surgeries, treatments, imaging, and other medical records. We may also perform an examination under anesthesia to better understand the location and extent of the fistula and to assess the quality of the surrounding tissue.
We have extensive experience with perineal repair of complex rectourethral fistulas. The perineal approach provides excellent access to both the urinary tract and rectum, allowing the fistula to be carefully separated and repaired.
One important advantage of this approach is that other problems involving the urinary tract - such as a urethral stricture - can often be addressed during the same operation. It also provides access for placement of healthy, well-vascularized tissue, such as a gracilis muscle flap, between the urinary and rectal repairs.
The operation typically involves:
Because these operations can involve significant scarring and complex anatomy, experience with the perineal approach and reconstructive techniques is particularly important. Our approach is tailored to the individual patient, with the goal of achieving a durable fistula closure while preserving urinary and bowel function whenever possible.