Rectourethral fistula: Surgical approaches and insights from our experience and literature review

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Abstract
Objectives: To present our experience and outcomes in the surgical management of rectourethral fistula (RUF). Materials and methods: We retrospectively analysed data from 11 patients treated for RUF between 2015 and 2024. Patient demographics, aetiology, fistula complexity, surgical approach, and outcomes were reviewed. Results: The mean patient age was 29 years (range = 18–62). In 81% of cases, RUF resulted from road traffic accidents, and four patients had previously failed repairs. All patients underwent suprapubic catheter placement and faecal diversion before definitive surgery. Seven patients (63.6%) had a complex fistulas, while four had simple ones. The perineal approach was used in eight patients (72.7%), with a transpubic in two patients (18.18%) and cystectomy with ileal conduit diversion in one patient (9%). The gracilis muscle interposition flap was used in most cases. At a 1-year follow-up, no patients experienced per rectal leakage, and 81% had catheter removal by 3 months. Conclusion: Our study demonstrates that with thorough evaluation and proper management, RUF closure rates can reach up to 100%. The pedicled gracilis muscle flap is highly effective for interposition in complex cases. Level of evidence: 2c

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