Rectourinary fistula is an uncommon entity with many causes for which the optimal management remains unclear. To clarify this, a 30-year experience with acquired rectourinary fistula at the Mayo Clinic was reviewed. In the management of 57 patients, 34 patients underwent repair of rectourinary fistula, the success rate being 88 per cent and the morbidity 29 per cent. Based on this experience, a simple plan of management emphasizing etiologic and prognostic factors is presented. Repair of rectourinary fistulas can be undertaken with a high degree of success and acceptable morbidity for patients with fistulas of benign cause and for those with fistulas of malignant cause who have no gross evidence of malignancy, minimal induration from irradiation, and anticipated long-term survival. Colostomy as an adjunctive procedure is usually unnecessary in the repair of fistulas associated with benign conditions.
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