Management of acquired rectourinary fistulas: how often and when is permanent fecal or urinary diversion necessary?

Purpose: The objective of this study was to evaluate our experience in the management of acquired rectourinary fistulas at our tertiary center.

Methods: Eighteen patients with fistulas treated from 1999 to 2004 were retrospectively reviewed for demographics, etiology of the fistulas, treatment, and outcome.

Results: The median age of the group was 69 years. Sixteen patients had fistulas that were malignant-associated. One patient died from tumor progression before any surgical therapy. The remaining 17 patients underwent surgical treatment of the fistula with a median of one procedure per patient. Eight patients had excision with permanent diversion, two had excision with repair/reconstructive procedures, and seven had repair surgical procedures. Initial surgical management was successful for 13 (76 percent) patients. Reoperation resulted in a final success rate of 100 percent. The rates of permanent fecal, urinary, and fecal plus urinary diversion in the malignant associated fistula group were 5.8, 47, and 5.8 percent, respectively. The median follow-up for all patients was 9.5 months. There were no procedure-related mortalities and five (29 percent) patients had significant surgical-related morbidity.

Conclusions: Our data suggest that surgical treatment for acquired rectourinary fistulas can successfully avoid permanent fecal and/or urinary diversion in a large number of patients if locally curative cancer treatment can be achieved.