Rectovaginal and Rectourethral Fistulas

Rectovaginal and rectourethral fistulas occur infrequently but result in devastating complications to patients. They also pose unique challenges to the surgeons treating these fistulas. A thorough evaluation should be performed to determine the location, size, and etiology of the fistula that may include trauma, infection, inflammatory bowel diseases, radiation, postoperative complications, and malignancy. Some fistulas may close spontaneously but most require surgical treatment. The options for repair include transrectal, transvaginal, or transperineal approaches and transabdominal approaches. Successful management of these fistulas involves recognizing the etiology, location, local tissue quality, and overall medical health of patients.