A rectourethral fistula is an abnormal connection between the rectum and the urethra, allowing unintended passage of contents. This condition can significantly impact quality of life.
Understanding Rectourethral Fistula
A fistula is an abnormal passageway connecting two organs or vessels that do not normally connect. A rectourethral fistula specifically connects the rectum, the final section of the large intestine, and the urethra, the tube that carries urine out of the body.
In males, the urethra extends from the bladder, passing through the prostate gland, and then through the penis. The rectum is located behind the prostate and bladder. This anatomical proximity means an abnormal opening can form between them. The condition is primarily observed in males due to the close relationship of these structures.
Recognizing the Signs
Individuals with a rectourethral fistula often experience symptoms related to the mixing of urine and fecal matter. A common sign is the passage of gas or stool through the urethra, known as pneumaturia and fecaluria. This can result in urine that appears cloudy, contains particulate matter, or has a foul odor.
Recurrent urinary tract infections (UTIs) are also frequently observed because bacteria from the rectum can enter the urinary tract. Some individuals might also experience urinary incontinence (involuntary leakage of urine) or fecal incontinence (inability to control bowel movements). Pelvic pain or discomfort, as well as pain during urination or defecation, can also occur.
Identifying the Causes
Rectourethral fistulas typically develop as a complication of medical conditions or procedures. Many cases arise from complications following prostate or rectal surgery, such as prostatectomy for prostate cancer or other pelvic surgeries. During these procedures, accidental injury to the rectal or urethral wall can occur, leading to fistula formation.
Radiation therapy, often used to treat pelvic cancers like prostate cancer, is another common cause. Radiation can damage tissues, impairing their blood supply and healing capacity, which makes them more susceptible to breakdown and fistula formation. Pelvic trauma, such as injuries from accidents or gunshot wounds, can also directly cause a rectourethral fistula. Inflammatory conditions like Crohn’s disease, which can cause chronic inflammation and abscess formation in the bowel, may also lead to their development.
Diagnostic Approaches
Diagnosing a rectourethral fistula involves a combination of physical examination and specialized imaging studies. A physical examination may be performed to assess the pelvic area. Imaging techniques are then used to confirm the presence and precise location of the fistula.
Cystography, which involves filling the bladder with a contrast dye, can reveal if urine is leaking into the rectum. Fistulography, where contrast dye is injected directly into the fistula tract, helps visualize its path and extent. Magnetic resonance imaging (MRI) provides detailed images of the fistula and surrounding structures. Endoscopic procedures like cystoscopy and colonoscopy allow for direct visualization of the fistula opening.
Treatment Pathways
Treatment for a rectourethral fistula is complex and individualized, depending on factors such as its size, location, cause, and the patient’s overall health. Conservative management may be considered for smaller, less symptomatic fistulas. This can involve prolonged urethral catheterization, dietary modifications, and nutritional support.
However, spontaneous closure of complex fistulas is rare, especially in cases involving radiation-damaged tissue. Most rectourethral fistulas require surgical repair to close the abnormal connection. Surgical approaches vary and may involve closing the holes in the rectum and urethra, often with healthy tissue placed between repaired sites. Temporary diversion of urine or stool may be necessary before or during definitive repair to allow healing.