AB061. Trickier and tips for surgical treatment of complex male urethral fistula

The male urethral fistula is the common and difficult complication of the surgical treatments of urethral stricture, hypospadias and prostate disease. Surgical reconstruction remains the mainstay in the management. Sometime the surgical therapy of the male urethral fistula is still a challenge. The key point of the treatment of anterior urethral fistula is using Dartos Fascia flap to overlapping it in one-two layer fashion. For posterior urethra, rectourethral fistula is great challenge. But unfortunately, the rectourethral fistula is becoming increasingly common with earlier diagnosis of prostate cancer, which is amenable to treatment with radical prostatectomy. Surgical approaches for definitive repair include the perineal, transanal, and combined abdominoperineal approaches. Perineal approach is good for rectourethral fistula with posterior urethral stricture. Transanal approach, the York-Mason approach, is good choice for small rectourethral fistula without posterior urethral stricture. We also use a new approach with combine perineal approach with transanal approach for some big rectourethral fistula without posterior urethral stricture. Among the numerous methods for closure of rectourinary fistulae, no single procedure has been proved most efficacious. However, it has become clear that a more aggressive surgical approach is necessary when local tissue integrity is dubious.