Rectal advancement flap repair of rectourethral fistula: a 20-year experience.
OBJECTIVE
Several procedures have been described for the management of rectourethral fistula. There has been no consensus on the best method of repair. The aim of this study was to review our experience with treatment of rectourethral fistula, focusing on the outcomes of rectal advancement flap repair.


METHODS
Data collected included demographics, cause, procedure type, presentation, operative details, and morbidity. Telephone follow-up was conducted to evaluate functional outcome and quality of life.


RESULTS
From 1981 to 2001, 23 male patients (age, 54 +/- 15 years) were treated for rectourethral fistula. Fecal diversion alone was performed in seven patients (30 percent), and urinary diversion alone was performed in one patient (4 percent). Both fecal and urinary diversion were performed in 12 patients (52 percent), and no diversion was performed in 3 (13 percent). Four patients were managed conservatively with diversion only. Nineteen patients underwent definitive repair. Rectal advancement flap repair was used in 12 (52 percent) of the cases. Postoperative length of stay was 4.5 +/- 4 days. Patients were followed up for an average of 31 +/- 33.4 months. Rectal advancement flap achieved primary closure in 8 (67 percent) of 12 patients. There were four recurrences. Two patients underwent successful repeat repair, for a final success rate of 83 percent. Morbidity associated with rectal advancement flap was 8 percent (1/12 patients). Cleveland Global Quality of Life score averaged 0.82 +/- 0.13.


CONCLUSIONS
The rectal advancement flap provides an effective repair for rectourethral fistula. Successful repair can be achieved in a majority of patients with minimal morbidity, short length of stay, and a good postoperative quality of life.
Garofalo
Thomas E
TE
Department of Colon and Rectal Surgery, Cleveland Clinic Foundation, Ohio, USA.
Delaney
Conor P
CP
Jones
Sandra M
SM
Remzi
Feza H
FH
Fazio
Victor W
VW
D000328:Adult; D000368:Aged; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012003:Rectal Fistula / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000601:surgery*; D014547:Urinary Diversion; D014548:Urinary Fistula / Q000601:surgery*