TREATMENT OF URETHRORECTAL FISTULA BY TRANSANAL ENDOSCOPIC SURGERY: STANDARDIZATION AND CRITICAL ANALYSIS

Case Presentation A 56-year-old male underwent open radical prostatectomy for prostate adenocarcinoma. He developed severe peritonitis and septic shock on the 8th postoperative day due to rectal perforation. Laparotomy was performed with cavity lavage, loop colostomy, and prolonged bladder catheterization. After recovery, he developed urinary leakage through the anus. A proctological examination revealed an anterior rectal opening, 3 cm from the anal rim, 10 mm in diameter, with retraction of the adjacent mucosa. Surgical treatment for urethrorectal fistula (URF) through a transanal approach was indicated. Dissection and removal of fibrous tissue were performed, exposing the urethral and rectal openings. A layered suture was applied, interposing a submucosal flap from porcine small intestine between the urethral and rectal sutures. The bladder catheter was kept in place for two months and was removed after confirming complete closure of the fistula through voiding uretrocystography.

Discussion Urethrorectal fistula (URF) is an uncommon condition, predominantly iatrogenic, particularly following prostatectomy or rectal surgeries, although it may also result from trauma, radiotherapy, or pelvic inflammatory processes. The standard treatment is surgical, and the approach can influence success rates, recurrence, and the patient's quality of life. Several approaches have been described: transanal, transperineal, transsphincteric, and transabdominal. Regardless of the technique, the treatment of URF must adhere to surgical principles: adequate exposure with individualized anatomical structures, removal of foreign bodies or synthetic materials, careful dissection with minimal trauma, well-adapted tension-free suturing in layers, use of well-vascularized flaps, urinary drainage, and prevention and treatment of infections with appropriate antibiotic use. The use of fecal diversion, before or after correction, is controversial. In the reported case, the transanal technique avoided combined abdominal approaches and provided good exposure of the surgical field, with a low risk of severe sequelae, as there was no excessive sphincter manipulation.

Conclusion Transanal endoscopic surgery proved to be effective, with low morbidity, and should be considered for the surgical treatment of patients with urethrorectal fistula.

Publication History

Article published online:
25 April 2025