Modification of the anterior perineal transanorectal approach for complicated prostatic urethrorectal fistula repair

Abstract

Rectoprostatic fistulas can pose challenging problems for surgical reconstruction. We describe and illustrate the successful repair of a difficult, post-traumatic prostatic urethrorectal fistula by combining use of a vascularized scrotal dartos flap interposition with a modified anterior rectal wall flap fistula repair (Park's technique). An anterior perineal transanorectal, transanorectal, transsphincteric approach provided excellent operative exposure as well as a direct path for the perineal pedicled dartos island flap en route to the fistula repair site.