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Urethro Rectal Fistula How to Repair

A. Abdullah¹

¹Liaquat National Hospital, Urology, Karachi, Pakistan

Introduction:

Urethrorectal fistula is a rare condition, typically resulting from trauma or following prostate and rectal surgeries. It is a debilitating condition, often associated with sepsis and the passage of fecal matter through the urethra. Due to the limited number of cases, repair can be challenging. In this report, we share our experience of repairing urethrorectal fistulas over the past five years. The majority of our cases are victims of bomb blasts, with the remaining cases arising from road traffic accidents and post-colon surgery complications. In many instances, simple repairs performed by general surgeons via the abdominal route often result in recurrence of the fistula. We have found that performing a perineal repair with interposition of the Gracilis muscle between the urethra and rectum provides more favorable outcomes.

Material and methods:

Over the past five years, we have performed surgery on more than 65 cases of urethrorectal fistula. Of these, 43 cases were due to shrapnel injuries, 13 resulted from road traffic accidents (RTAs) with associated pelvic fractures and concurrent urethral distraction injuries, and 10 were post-coloanal surgeries for rectal cancer. Approximately 80% of the cases required fecal diversion with a de functioning colostomy, while the remaining cases were managed without a diverting colostomy. All patients underwent repair with interposition of the Gracilis muscle. Additionally, 13 cases involved concurrent end-to-end urethroplasty during the same surgical procedure.

Results:

Out of the 65 cases, 62 were successfully repaired. However, in the remaining 3 cases, revision surgery was required due to the movement of the Gracilis muscle, which did not adequately cover the repaired area.