Frequently Asked Questions About Urinary Fistula Repair

A rectourethral fistula (RUF) is an abnormal connection between the urethra and rectum. This allows urine to pass into the rectum and stool or gas to enter the urinary tract, causing recurrent infections, pneumaturia (gas in urine), fecaluria (stool in urine), and urinary leakage from the rectum.

The most common cause is prior prostate cancer treatment, particularly surgery or radiation therapy. Other causes include inflammatory bowel disease, pelvic trauma, infection, and complications from other pelvic procedures. Radiation-associated fistulas are particularly challenging.

A pubosymphyseal fistula is an abnormal connection between the urethra and the pubic bone, often associated with chronic infection (osteomyelitis) of the bone. This typically occurs after pelvic fractures, prior urethral surgery, or chronic catheter use.

Diagnosis involves cystoscopy, contrast imaging studies (retrograde urethrogram, cystography, MRI), and sometimes examination under anesthesia. Determining the exact location and size of the fistula, presence of radiation damage, and bone involvement is critical for planning repair.

Timing depends on the cause and situation. Post-surgical fistulas should be allowed to mature for 3-6 months before repair. Radiation-associated fistulas require careful assessment of tissue quality. Infections and inflammation must be controlled before definitive repair.

Surgery typically involves complete excision of the fistula tract, closure in multiple layers, and interposition of healthy tissue (muscle or fat flaps) between the urethra and rectum to prevent recurrence. Complex cases may require temporary urinary and fecal diversion.

Success rates vary significantly based on cause and complexity. Simple post-surgical fistulas achieve a 98% success. Radiation-associated fistulas are more challenging with a 86% success rates. Multiple prior failed repairs may have lower success rates but can still be repaired successfully.

Recovery typically requires 4-6 weeks of restricted activity. A urinary catheter remains in place for 4-6 weeks during healing. Most patients can return to normal activities after catheter removal.

Rectourethral fistula repair typically takes 2–5 hours, depending on the size, location, and complexity of the fistula. More complex cases involving prior radiation or multiple prior repairs may take longer.