Minimally invasive approach for complex rectourethral fistulas: Dual urethral and rectal advancement, technical description, and clinical outcomes

Rectourethral fistulas can severely affect patients' quality of life. Conservative measures are rarely sufficient and patients often require surgical management. To achieve the best repair, a tailored combination of surgical techniques can be chosen depending upon the clinical scenario. The purpose of this article is to describe the initial experience with a robotic-assisted transabdominal fistula takedown via the Turnbull-Cutait pull-through technique and perineal urethral advancement for complex rectourethral fistulas (RUFs) in selected patients desiring orthotopic urinary and fecal continuity. We detailed the treatment of complex RUFs due to previous radiation injury from prostate cancer in two patients. Patient 1 is a 68-year-old male who developed an RUF following stereotactic body radiotherapy and salvage high-intensity focused ultrasound; Patient 2 is an 82-year-old male who developed an RUF after brachytherapy and external beam radiation. Staged reconstruction was used in Patient 1, and single-session repair in Patient 2. Promising initial results using this strategy exist for the repair of complex RUFs in selected patients interested in maintaining orthotopic urinary and fecal continence.