Urethrorectal fistula. Report of 11 cases.

The authors report a series of 11 urethrorectal fistulas observed over a 25 -year period. The mean age of the patients was 37 years (range: 15 to 70 ye ars). The aetiologies were surgical trauma (5 cases), fracture of the pelvi s (2 cases), inflammatory lesions (3 cases), and one fistula was congenital . The clinical features were dominated by urine discharge from the anus (11 cases), urinary tract infection (8 cases), spurious diarrhoea (6 cases), f aecaluria (4 cases), pneumaturia (2 cases). Digital rectal examination was normal in 7 patients. IVU demonstrated opacification of the rectum in 5 out of 8 cases. Cystourethrography, performed in 9 patients, demonstrated the communication in each case. Urethrocystoscopy visualized the fistula in eac h case in which it was performed. Treatment consisted of bladder drainage b y urethral catheter in all patients, allowing closure of the fistula in 2 p atients. Colostomy was performed in 2 patients, internal urethrotomy and ur ethral catheter was performed in 2 cases. Surgical closure of the fistula w as performed in 7 patients, via an abdominoperineal(3 cases), perineal (2 c ases), transperitoneal (1 case) or transanosphincteric incision(1 case).