Re-operative surgery for genitourinary fistulae to the colorectum

Re-operative surgery for genitourinary fistulas to the colorectum is very distressing condition for the patients. These fistulas are extremely complex and at times may require a staged, multidisciplinary approach in order to correct them. Post-operative and recurrent genitourinary fistula to the colorectum can occur as a consequence of pelvic disorders, including trauma, iatrogenic injury, inflammatory bowel disease, pelvic neoplasm, and infection. Basic surgical principles, such as gentle handling of the tissues, curetting of the fistula tract, adequate debridement of unhealthy tissue, and adequate mobilization of tissue to allow tension-free tissue approximation, are essential for a successful outcome. Surgical therapy for these fistulas remains largely based on the surgeons׳ preference and is influenced by many retrospective reports. Currently, there is no specific treatment algorithm available for these post-operative and recurrent genitourinary fistulas to the colorectum. Through this article, we will highlight the various treatment options available and have attempted to formulate a treatment algorithm for post-operative and recurrent rectourethral, rectovaginal, and ileal pouch vaginal fistulas.