rectourethrale

Rectourethral (rectourethrale) refers to anything involving both the rectum and the urethra. In medical terminology, it most commonly describes a rectourethral fistula, an abnormal channel between the rectum and the urethra. These fistulas can be congenital, most often in association with anorectal malformations in children, or acquired due to trauma, infections, surgical injury, radiation therapy, or malignancy.

Clinical features depend on fistula location and cause. Common symptoms include fecaluria (feces in urine), recurrent urinary tract infections, pneumaturia, and passage of stool through the urine stream; in neonates, there may be a fistulous tract detected during evaluation for anorectal malformation.

Diagnosis combines physical examination with imaging and endoscopy. Voiding cystourethrography or retrograde urethrography can delineate the tract; CT or MRI provides detailed anatomy; fistulography and cystoscopy or sigmoidoscopy may be used to map the tract and assess the rectal side.

Treatment is individualized and often staged. Small, low lesions in selected patients may be repaired perineally; higher or complicated fistulas often require abdominal or combined transabdominal/transperineal approaches. A protective urinary or fecal diversion, such as a colostomy, is sometimes employed to optimize healing. Interposition of tissue, such as muscle or omental flaps, can help reduce recurrence. Antibiotics are used for infection control.

Prognosis varies with fistula size, etiology, and surgical expertise, but many patients achieve fistula closure and restoration of continence with modern techniques. See also fistula, anorectal malformations.