Rectourethral fistula: A challenging management problem
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RE VIE W AR T I CL E
Rectourethral Fistula: A Challenging Management Problem M. Stamatakos, K. Ntzeros, G. Christis, F. Anyfanti, S. Sotirianakos
Abstract Aim: To describe the problems and management of rectourethral fistulas. Background: Rectourethral fistula constitutes a rare entity that poses a challenging management problem. The
condition is either congenital or acquired. The clinical findings suggestive of RUF include pneumaturia, faecaluria, and urine leakage per rectum. Methods: This study was based on English research literature, mainly by searching PubMed bibliographic database. Results: Diagnosis of a rectourethral fistula is difficult and often based on history alone. In rare cases, non-operative
management has been successful, but the majority of patients require surgical intervention. A wide variety of procedures have been described for RUF repair. Conclusions: Rectourethral fistula represents a complex management problem for any surgeon. Surgical treatment of RUF is technically demanding and requires collaboration with rectal surgeons. Key words: Rectourethral fistula; pneumaturia; fecaluria; diagnosis; treatment
Classification-Aetiology Rectourethral fistulas (RUF) may have a congenital or acquired origin [1]. Culp and Calhoon described five basic groups of RUF according to their aetiology: congenital, iatrogenic, traumatic, neoplastic and inflammatory [2]. Congenital rectourethral fistula is typically addressed by the paediatric surgeon during repair of anorectal abnormalities [3,4]. RUF persisting after anoplasty could either be the result of a congenital anomaly which was not recognized and fixed, or a iatrogenic complication caused by surgical injury to the urethra. It is also concluded that the prenatal diagnosis of enterolithiasis and lower bowel obstruction should alert practitioners to a possible rectourinary fistula. According M. Stamatakos Department of Surgery, Nursing Unit of Molaoi, General Hospital of Lakonia, Greece K. Ntzeros Medical Centre of Astros, Panarcadian General Hospital of Tripolis, Greece G. Christis Internal Medicine, Evangelist Hospital, Herne Germany F. Anyfanti Internal Medicine, Evangelist Hospital, Herne Germany S. Sotirianakos Department of Surgery, Nursing Unit of Sparti, General Hospital of Lakonia, Greece Corresponding author: Stamatakos Michael MD, PhD Elos, Dimos Eyrota, Lakonia, Greece, Postal Code 23055 Tel: +306944133068, e-mail: [email protected] Received 6 March 2016; Accepted 23 March 2016
Hellenic Journal of Surgery 88
to a Japanese registry of anorectal malformations, the risk of an additional rectourinary communication reaches 25% [5]. Prolonged stasis with an admixture of urine and meconium has been suggested as a possible cause of bowel calcifications in an imperforate anus [6]. This hypothesis is supported by a review of the literature which revealed that a urine-containing fistula is present in 82% of cases with enterolithiasis and anorectal obstruction. The role of intestinal stasis and urine passage into the distal part of the colon rem
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