Use of biological mesh in trans-anal treatment for recurrent recto-urethral fistula

Purpose: To report the author's experience on a miniinvasive technique using bioprosthetic plug and a rectal wall flap advancement in the treatment of recurrent rectourethral fistula. Materials and methods: Between 2013 and 2015, seven patients with recurrent recto-urethral fistula were referred to the Pederzoli Hospital, Peschiera del Garda, Verona,Italy. Intraoperatively all patients were found to have a rectal wall lesion and were treated with urinary and fecal diversion. For the persistence of the fistula, all the patients underwent a mini-invasive treatment consisting on placement of a bioprosthetic plug in the fistula covered by an endorectal advancement flap through a trans-anal and transurethral combined technique. Results: Median operative time was 48 min with a median blood loss of 30 ml. Median hospital stay was 3 days (IQR 1-3). No case of fistula recurrence or plug migration was described. None of the patients experienced fecal or urinary incontinence. All patients obtained complete fistula healing. Conclusions: Recurrent recto-urethral fistula is a challenging postsurgical complication for surgeons and urologists