Chen Shulian, Gao Rang, Li Hong, Wang Kunjie
Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Asian J Urol. 2018 Jul;5(3):149-154. doi: 10.1016/j.ajur.2018.01.003. Epub 2018 Jan 31.
Rectourethral fistula is an uncommon but devastating condition resulting from surgery, radiation, trauma, inflammation, or occasionally anorectal anomaly. Because of involving the urinary and the digestive system, surgical repair can be challenging. More than 40 different surgical approaches were described in the literature. However, no standardized management exists due to the rarity and complexity of the problem. Spontaneous closure of fistula is rare and most cases need reconstructive procedures. Appropriate preoperative assessment is crucial for the decision of operation time and method. Gradually accumulating evidence indicates surgeons should take fistula size, tissue health and vascularity associated with radiation or infection, urethral stricture, and bladder neck sclerosis into consideration and make a proper treatment plan according to the features of various approaches. Accurate preoperative evaluation and proper approach selection would increase success rates. Multiple surgical team corporation, including colorectal, urological and plastic surgeons, would optimize the outcomes.
直肠尿道瘘是一种不常见但极具破坏性的病症，由手术、放疗、创伤、炎症引起，偶尔也由肛肠畸形导致。由于涉及泌尿系统和消化系统，手术修复具有挑战性。文献中描述了40多种不同的手术方法。然而，由于该问题的罕见性和复杂性，目前尚无标准化的治疗方案。瘘管自发闭合的情况很少见，大多数病例需要进行重建手术。适当的术前评估对于确定手术时间和方法至关重要。越来越多的证据表明，外科医生应考虑瘘管大小、与放疗或感染相关的组织健康和血管情况、尿道狭窄以及膀胱颈硬化，并根据各种手术方法的特点制定合适的治疗方案。准确的术前评估和正确的手术方法选择将提高成功率。包括结直肠外科医生、泌尿外科医生和整形外科医生在内的多个手术团队合作，将优化治疗效果。
