Reconstructive Urology & Men's Health
What is a fistula?
What are some of the causes of a fistula?
How does a patient know when they get a fistula?
What happens after the fistula is diagnosed?
How are recto-urethral fistula treated?
Is recovery from surgery difficult?
A fistula is an abnormal hole in the bowel or the bladder. A recto-urethral fistula is a hole between the urethra (urinary channel) and the rectum. This hole leads to leakage of urine into the rectum and feces travelling into the bladder.
The most common cause of this problem is either surgery on the bowel or treatment for prostate cancer. Radiation to treat prostate cancer is particularly notorious for leading to these fistulas. Other treatments for prostate cancer that can cause a fistula are cryotherapy, surgery, high intensity focused ultrasound and proton beam radiation.
One of the telltale signs of a fistula is urine leaking out the rectum. Another sign is severe urinary tract infections. Patients can sometimes become very ill at the time of diagnosis of this fistula.
It is important to divert the flow of feces away from the urinary tract and treat infections when a fistula is first diagnosed. The way the feces are diverted is a colostomy. In this surgery the colon or small bowel is brought up to the skin and sewn in place. A stoma bag is pasted to the skin to collect the feces. This is a temporary measure until infection can be treated and the fistula is repaired. Often patients need to wait between the colostomy placement and the fistula repair to allow infection and inflammation to resolve. Occasionally fistula will heal spontaneously with only the colostomy surgery.
The treatment of a recto-urethral fistula is not easy. Each fistula is different and needs to be fully evaluated. Most fistulas can be treated by closure of the fistula and placement of a muscle flap from the leg between the rectum and the urethra. This muscle flap is essential to allow for healthy healing of this area. The hole in the rectum can also for the most part be simply closed. In some cases of large fistula a piece of the lining of the inner cheek, called buccal mucosa is used to close the hole in the prostate and urethra. The lining of the inner cheek is very similar to the lining of the urethra. This surgery takes several hours and the recovery will take many weeks afterward, but it is one of the only reliable ways of getting these fistula to close.
The recovery from this type of surgery is difficult. There are incisions that are extensive and adequate time must go by before removal of catheters from the urinary system. Usually, this is 4-6 weeks. Once the fistula has healed and an adequate time has passed to make sure the hole will not recur than the colostomy can be reversed. This time frame is usually about 3-6 months after removal of all the urinary catheters. During this post operative period patients are followed very closely by Dr. Myers and the staff at University of Utah. Follow up with an outside urologist can also usually also be arranged in close conjunction with our hospital. This can be done throughout the nation.
William O. Brant, M.D.Locations
|Redstone Health Center||(801) 213-2700|
|University Hospital||(801) 213-2704|
Specialties: Erectile Dysfunction, General Urology, Male Incontinence, Men's Health, Trauma and Reconstructive Urology, Urology, Vasectomy
Colleen A. Lowe, ANPLocations
|University Hospital||(801) 581-7674|
Specialties: Erectile Dysfunction, Men's Health, Nurse Practitioner, Trauma and Reconstructive Urology, Urology
Jeremy B. Myers, M.D.Locations
|University Hospital||(801) 213-2702|
Specialties: General Urology, Neurogenic Bladder, Trauma and Reconstructive Urology, Urinary Diversion, Urinary Strictures and Fistula, Urology, Vasectomy
Kathryn M. Trueheart, PA-C, MPAS
Specialties: Erectile Dysfunction, Men's Health, Physician Assistant, Trauma and Reconstructive Urology, Urology