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A systematic review on the surgical management of acquired rectourethral fistula

International Journal of Impotence Research (2025)Cite this article

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Abstract

Recto-urethral fistulas represent a rare and challenging condition, occurring either congenitally or due to various prostatic and pelvic interventions such as radical prostatectomy and radiation therapies. This condition often manifests with symptoms such as pneumaturia, fecaluria, and urinary tract infections. Despite its rarity, this condition presents significant clinical management challenges due to the lack of consensus on standardized treatment protocols, particularly in patients with a history of irradiation. This study aims to systematically review the available literature on the efficacy and safety of primary surgical repair of adult-acquired recto-urethral fistulas. We conducted a comprehensive bibliographic search of MEDLINE, Scopus, and Web of Science Core Collection databases in August 2024, following the PRISMA guidelines. A total of 10 studies, covering over 500 patients, were included in our review. The most common surgical approach used was the transperineal technique with gracilis muscle flap interposition. Findings indicate higher complication rates and diminished healing in irradiated patients compared to non-irradiated counterparts. Although transperineal approaches generally resulted in high success rates irradiated individuals frequently required additional surgeries or definitive urinary diversion. Further research is required to establish evidence-based guidelines for optimal management, particularly for complex cases involving radiation-induced recto-urethral fistulas.

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Fig. 1: PRISMA 2020 flow diagram for the selection of studies.
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Fig. 3: Gracilis interposition for surgical correction of recto-uretral fistulas.
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Author notes

  1. These authors contributed equally: Mattia Lo Re, Marta Pezzoli.

Authors and Affiliations

  1. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Mattia Lo Re & Marta Pezzoli

  2. Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy

    Mattia Lo Re, Marta Pezzoli, Andrea Cocci & Andrea Minervini

  3. Department of Urology, Hospital Universitario HM Sanchinarro, Instituto Investigación Sanitaria HM Hospitales and ROC Clinic, Madrid, Spain

    Esther Garcia Rojo & Javier Romero-Otero

  4. Department of Urology, Hospital Universitario HM Puerta del Sur, Instituto Investigación Sanitaria HM Hospitales and ROC Clinic, Madrid, Spain

    Manuel Alonso Isa

  5. Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Celeste Manfredi

  6. Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy

    Francesco Sessa

  7. Department of Urology, Hospital Universitario HM Rivas, Instituto Investigación Sanitaria HM Hospitales and ROC Clinic, Madrid, Spain

    Agustin Fraile Poblador

Authors
  1. Mattia Lo Re
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  2. Marta Pezzoli
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  3. Esther Garcia Rojo
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  4. Manuel Alonso Isa
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  5. Celeste Manfredi
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  8. Andrea Minervini
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  10. Javier Romero-Otero
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Contributions

MLR, MP, and JRO have given substantial contributions to the conception and design of the manuscript. MLR, CM, EGR and MAI participated to drafting the manuscript. AC, AM, and JRO revised it critically. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Javier Romero-Otero.

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Lo Re, M., Pezzoli, M., Garcia Rojo, E. et al. A systematic review on the surgical management of acquired rectourethral fistula. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01100-y

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