Transperineal Repair of Rectourethral Fistula: Surgical Technique and a Case Report
Weerapat Suwanthanma MD*, Wit Viseshsindh MD*, Chakrapan Euanorasetr MD*, Chairat Supsamutchai MD*, Chalila Promtong BNS**
Affiliation : * Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ** Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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
