A 60-year old Thai male diagnosed as iatrogenic rectourethral fistula. Preoperative investigation
with intravenous pyelogram revealed connection between urethra and rectum. Colonoscopy also revealed
fistula opening at mid-rectum. He underwent surgery via transperineal approach. Intraoperative fistula
localization was performed using Methylene blue injection via foley catheter. The fistula tract was identified
and divided exposing blue-staining tract. Rectal opening and urethral opening were repaired. Fecal and
urthral diversion were performed. Postoperative period was uneventful. The final pathologic report of fistula
tract was fibrosis. The perineal and rectal wounds were healed without complication. The suprapubic
cystostomy catheter was removed at the end of the second month together with the colostomy closure.

Keywords: Rectourethral Fistula, Transperineal repair, Levator ani muscle