Combined Endoscopic Closure of Rectourethral Fistula

PURPOSE: Rectourethral fistula formation is a rare complication of radical prostatectomy and other pelvic surgical procedures. MATERIALS AND METHODS: In 2 patients endoscopic closure of the fistula was performed by combined transrectal endoscopic excision of the fistula, endoscopic suture, and simultaneous transurethral fulguration and fibrin application. RESULTS: This combined approach resulted in closure of the fistula in both patients as proved by rectoscopy, retrograde urethrography and disappearance of all clinical symptoms. The latest postoperative followup was 18 months. CONCLUSIONS: Any open procedure to correct a rectourethral fistula is considered major surgery. Therefore, the minimally invasive approach described should be attempted first in patients with a small rectourethral fistula.