Annals of Coloproctology

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Original Article

Complications

Comparative outcomes of early and late rectourethral fistula: insights from a multicentric retrospective study on multidisciplinary management strategies: Pauline Jeannot, Edouard Roussel, Alexandre Dutoit, Maxime Collard, Niki Christou, Jérémie H. Lefevre, Amine Souadka, Alves Arnaud, Antonio Castaldi, Martin Bertrand, Nicolas Michot, Benjamin Faivre d’Arcier, Jean Jacques Tuech, Franck Bruyère, Urs Giger-Pabst, Mehdi Ouaïssi, for the French Research Group of Rectal Cancer Surgery (GRECCAR); Ann Coloproctol. 2026;42(1):103-114. Published online February 27, 2026; DOI: https://doi.org/10.3393/ac.2025.00696.0099

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Abstract PDF: Purpose
The objective of this study was to evaluate the natural history of early and late rectourethral fistulas (RUFs) and to determine the long-term outcomes of a multidisciplinary management approach.
Methods
A multicenter retrospective study was performed on patients with RUF who were treated by a combined colorectal and urological team. Early RUF (ERUF) was defined as occurring within 31 days after surgery, while late RUF (LRUF) was defined as occurring thereafter. Surgical procedures and the surgeons involved were recorded, in addition to clinical assessments, radiological findings, and oncological assessments.
Results
A total of 72 patients diagnosed with RUF were treated between January 1, 2010, and June 2023. Patients were divided into ERUF (n=37) and LRUF (n=35) groups. After conservative management, comparisons of success rates for graciloplasty, York-Mason, and delayed coloanal anastomosis as second and third treatments showed higher rates for graciloplasty in ERUF than in LRUF (83% vs. 40%, P=0.034; 71% vs. 33%, P=0.500; and 60% vs. 40%, P>0.999, respectively). The ERUF group demonstrated significantly higher cure rates after the second treatment (83.8% vs. 40.0%, P<0.001). At final follow-up, complete healing was significantly more frequent in ERUF than in LRUF (83.8% vs. 42.9%, P<0.005). Definitive digestive and urinary diversion rates were lower in ERUF (13.5% vs. 48.5%, P=0.001; and 13.5% vs. 25.7%, P=0.240, respectively).
Conclusion
These findings suggest that 30% of patients required a definitive colostomy, with a significantly higher proportion observed in the LRUF group. Moreover, repeated surgical procedures in the LRUF group were frequently unsuccessful.

Case Report

Treatment of a Recurrent Rectourethral Fistula by Using Transanal Rectal Flap Advancement and Fibrin Glue: A Case Report: Taek-Gu Lee, Sung-Su Park, Sang-Jeon Lee; J Korean Soc Coloproctol. 2012;28(3):165-169. Published online June 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.3.165

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10 Citations

Abstract PDF

Rectourethral fistulas (RUFs) in adults are rare and could result from complicated trauma, and prostatic or rectal surgery. RUFs have been treated initially by using primary repair and omental interposition with or without a colostomy during surgery. Recurrent RUFs require complex surgery, such as a low rectal resection and coloanal anastomosis, an interposition flap of the datos muscle or gracilis muscle, and others. Recently, transanal rectal flap advancement and fibrin glue injection have provided an effective occlusion of RUFs. However, no reports about this technique exist for cases of recurrent RUFs. We report a case of a recurrent RUF successfully repaired by using transanal rectal flap advancement combined with fibrin glue injection into the fistula tract. The postoperative course was uneventful without complications. At the 1-year follow-up, no complications such as urethral stricture or recurrence existed, and voiding was normal without anal incontinence.

Citations

Citations to this article as recorded by

Fistules recto-urétrales après traitement pour cancer de la prostate : mise au point et nouvel algorithme de prise en charge
Maëlig Poitevin, Matthieu Ferragu, Pierre Bigot, Thibaut Culty, Aurélien Venara
Journal de Chirurgie Viscérale.2025; 162(3): 213. CrossRef
Rectourethral fistulas after treatment for prostate carcinoma: Update and new management algorithm
Maëlig Poitevin, Matthieu Ferragu, Pierre Bigot, Thibaut Culty, Aurélien Venara
Journal of Visceral Surgery.2025; 162(3): 199. CrossRef
“Robotic-assisted surgical management of a post-brachytherapy rectoprostatic fistula: a case report”
Artem Goncharov, Vadim Shindyapin, Alexander Popov, Aramais Aslanyan, Emil Abdryakhimov
BMC Urology.2025;[Epub] CrossRef
Rectourethral fistula following focal irreversible electroporation for prostate cancer
Sean Ong, Zein Alhamdani, Nathan Lawrentschuk
BMJ Case Reports.2022; 15(9): e249816. CrossRef
Tratamiento de las fístulas uretrorrectales tras prostatectomía radical mediante la interposición de material biológico vía perineal
J.U. Juan Escudero, F. Villalba Ferrer, M. Ramos de Campos, M. Fabuel Deltoro, M.J. García Coret, F. Sánchez Ballester, I. Povo Martín, Y. Pallas Costa, P. Pardo Duarte, J. García Ibañez, A. Monzó Cataluña, K. Rechi Sierra, C. Juliá Romero, E. López Alcin
Actas Urológicas Españolas.2021; 45(5): 398. CrossRef
Treatment for rectourethral fistulas after radical prostatectomy with biological material interposition through a perineal access
J.U. Juan Escudero, F. Villaba Ferrer, M. Ramos de Campos, M. Fabuel Deltoro, M.J. Garcia Coret, F. Sanchez Ballester, I. Povo Martín, Y. Pallas Costa, P. Pardo Duarte, J. García Ibañez, A. Monzó Cataluña, K. Rechi Sierra, C. Juliá Romero, E. Lopez Alcina
Actas Urológicas Españolas (English Edition).2021; 45(5): 398. CrossRef
A rare case of tubercular recto-prostatic urethral fistula with tuberculous orchitis
Niramya Pathak, Mohan Keshavamurthy, Karthik Rao, Shakir Tabrez, Mohan Balaiah Ashwathaiya, Premakumar Krishnappa
Urology Case Reports.2020; 33: 101355. CrossRef
Management of acquired rectourethral fistulas in adults
Shulian Chen, Rang Gao, Hong Li, Kunjie Wang
Asian Journal of Urology.2018; 5(3): 149. CrossRef
Re-operative surgery for genitourinary fistulae to the colorectum
Gokulakkrishna Subhas, Suraj Alva, Walter E. Longo
Seminars in Colon and Rectal Surgery.2015; 26(4): 229. CrossRef
Rectourethral Fistula: Systemic Review of and Experiences With Various Surgical Treatment Methods
Ji Hye Choi, Byeong Geon Jeon, Sang-Gi Choi, Eon Chul Han, Heon-Kyun Ha, Heung-Kwon Oh, Eun Kyung Choe, Sang Hui Moon, Seung-Bum Ryoo, Kyu Joo Park
Annals of Coloproctology.2014; 30(1): 35. CrossRef

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