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Rectourethral Fistula—Review of Current Practices, Developments, and Outcomes

  • Kirtishri Mishra
  • Nathan Y. Hoy
  • Hadley M. Wood
  • Kenneth W. AngermeierEmail author
Cancer-Associated Voiding Dysfunction (S Elliott and J Pariser, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cancer-Associated Voiding Dysfunction

Abstract

Purpose of Review

Rectourethral fistula (RUF) is an uncommon pathology associated with a significant deterioration in quality of life. It can result from a variety of etiologies and frequently occurs in medically complex patients. Due to the involvement of both the urinary and fecal systems, there are a number of treatment considerations. The literature surrounding management of this condition is quite varied due to these factors.

Recent Findings

Recent literature on the field consists primarily of single institution case series, though there is a recently published multi-center cohort study with a relatively larger sample size. There is no clear surgical technique that appears to be superior. Transperineal repair is the most commonly described approach. In the properly selected patient, RUF repair results in success rates approaching 85–90%, though the definition of success is not standardized in the literature, and success rates are lower in patients post radiation or ablative therapy.

Summary

This review highlights contemporary developments in the RUF literature, and provides an overview of important work-up and management considerations. Overall, there is no standardized protocol for management of RUF. Every case presents a unique challenge as a result of the RUF etiology, anatomical considerations, varying degrees of involvement of the genitourinary and gastrointestinal tracts, and patient comorbidities. Urologists must ultimately understand the disease process and utilize techniques that they feel most comfortable with.

Keywords

Rectourethral fistula Fistula Iatrogenic fistula Surgical repair Rectourethral fistula management 

Abbreviations

RUF

Rectourethral fistula

RP

Radical prostatectomy

IBD

Inflammatory bowel disease

XRT/AB

Radiotherapy/ablative

DRE

Digital rectal exam

AUS

Artificial urethral sphincter

VCUG

Voiding cystourethrogram

GGE

Gastrograffin enema

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kirtishri Mishra
    • 1
    • 2
  • Nathan Y. Hoy
    • 3
  • Hadley M. Wood
    • 3
  • Kenneth W. Angermeier
    • 3
    Email author
  1. 1.University Hospitals–Cleveland Medical CenterClevelandUSA
  2. 2.Case Western Reserve University School of MedicineClevelandUSA
  3. 3.Glickman Urological and Kidney Institute–Cleveland Clinic FoundationClevelandUSA

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