10- Rectourethral fistulas

A recent review of the literature shows an increasing number of studies on this subject, most of which are retrospective and presented solely from a clinical point of view. Some of them are no more than case-reports. There is a lack of valid epidemiologic data about the incidence of rectourethral fistulas. According to the literature, these fistulas result from many different causes. Rectourethral fistulas may have a congenital or acquired origin. Acquired cases include inflammatory, neoplastic, or traumatic etiologies. The diagnostic algorithm is clear and very classical. The new diagnostic approach represents an MRI investigation of the male urethra. It is important to recognize this diversity of etiology because each type requires a different surgical strategy. The aim of the surgical approach is the closure of all types of fistulas. Spontaneous closure of the recto-urethral fistulas after double diversion or by means of a one-stage procedure is possible only in a few cases. In most cases, the treatment proceeds in three stages (double diversion-urinary and bowel, closure technique, undiversion). An endoscopic approach using biological sealants seems to be promising. Few urologists and general surgeons have attained wide experience in the management of rectourethral fistulas. No single procedure has been proven most effective or even universally applicable.