Long term outcome of multidisciplinary management of urethro-rectal fistula after urologic surgery

Urethro-rectal fistula (URF) is a rare but serious condition whose treatment is poorly codified. This study aims to evaluate the short and long-term results of multidisciplinary management.

Material and methods: We retrospectively collected the records of patients with URF operated on at the University Hospital of Tours between January 1, 2000 and January 1, 2020. Short-term and long-term results according to management are reported.

Results: The study included 20 patients. As an initial gesture, 11 patients underwent bladder catheterization and colostomy, seven underwent bladder catheterization alone, one underwent graciloplasty, and one, a York Mason procedure. The success rate of initial conservative management was only 5% (1/20). As a secondary or tertiary intervention, ten patients underwent a York Mason procedure and nine underwent graciloplasty. At the end of the study period, with a median follow-up of 50 months, 19 had been effectively treated for URF, 16 were able to have colostomy closure with restoration of digestive continuity while four had a permanent stoma. One patient had anal incontinence, 14% had major stress urinary incontinence.

Conclusion: Multidisciplinary care remains a cornerstone of the treatment of URF because iterative surgeries may be required, with an overall success rate of up to 95% at the end of follow-up.