Surgical Management of Rectourinary Fistulae

Algorithm-based multidisciplinary treatment approach for rectourethral fistula

“…Although RUF healing can occur spontaneously, surgical intervention is often required [17]. Numerous surgical techniques have been described including transabdominal, transanal, transperineal, combined abdominoperineal, anterior and posterior transsphincteric, transsacral, and endoscopic minimally invasive approaches [1,2,4,[18][19][20][21][22][23][24]. Due to rarity of RUF, the heterogeneity of fistula etiology and morphology in addition to the various procedures available to treat it, a standardized approach to the management of this condition is lacking.…”

Management of rectourinary fistula after urological interventions using biodesigned mesh: first experiences of an innovative technique

“…Obvious advantages like limited postoperative morbidity, absence of skin incision, preservation of continence, and short operating time distinguish this technique from standard approach and probably outweigh limited instrument manoeuvrability, lack of interposed tissue, and poor visibility [15]. Especially after prostate removal, this access convinces because of a reduced distance between the fistula and anus [2]. Nevertheless, we think that limited instrument manoeuvrability gains in importance most notably in case of biomesh implantation, and therefore, reproducibility could only be ensured in experienced hands.…”

“…For radiated cases, gracilis muscle interposition may be preferred. Although surgical repair remains the gold standard, there is still no consensus concerning the management of RUF with no data available clearly favoring one approach [2,3]. Therefore, it is mandatory to look for innovative, minimally invasive procedures using biomaterials.…”

Feasibility of Gracilis Muscle Flap Interposition for Management of Recurrent Rectovesical/Rectourethral Fistulas: A Single Centre Expertise

“…It may not be feasible in patients who have undergone previous abdominal surgeries. Transposition of the gracilis muscle as a viable flap provides a well-vascularised muscle rotation flap, thereby avoiding the need for laparotomy [16]. …”