ACQUIRED RECTOURETHRAL FISTULA - METHODS OF REPAIR

Rectourethral fistulas are a rare but devastating complication of urin ary or rectal surgery, trauma or inflammation. Historically repair has posed a challenge because of technical difficulties and the high inci dence of recurrent fistulas. We report 7 cases of acquired rectourethr al fistulas of varying etiology (3 after prostatectomy, 3 after trauma and 1 after recurrent perineal abscess), which were managed by variou s means. Our data and those in the literature suggest that the first a ttempt at repair is the best and subsequent repairs become increasingl y difficult; the York Mason approach allows easy accessibility with mi nimal risk of complications and the best chance for a functionally suc cessful outcome when a vascularized flap is not required, and some cas es may have such a low probability of successful resolution of the fis tula as well as maintenance of urinary continence that cystectomy and supravesical diversion are appropriate considerations.