Transanal minimally invasive surgery (TAMIS): case report of a novel approach for rectourethral fistula repair

Background: Rectourethral fistula (RUF) is a relatively infrequent, but very difficult to resolve complication of prostatic interventions. Despite the numerous surgical approaches described for its definitive treatment, there is still no gold standard, mainly due to the high recurrence rate or morbidity associated with the procedure. The challenging nature of a universally effective intervention emphasizes the need for innovative strategies to address this complex condition. Case Description: This report describes the successful repair of an iatrogenic RUF through a comprehensive, multidisciplinary approach involving specialists in colorectal and urological surgery. The patient underwent diversion of both the digestive and urinary tracts initially to mitigate inflammation and optimize tissue healing. A transanal minimally invasive surgery (TAMIS) technique was subsequently performed for the definitive closure of the fistula. The combination of these approaches resulted in the resolution of symptoms, and subsequent follow-up assessments revealed no evidence of recurrence. Conclusions: This case demonstrates the challenge of managing iatrogenic RUFs and highlights the effectiveness of a multidisciplinary approach. The diversion of both the digestive and urinary tracts, combined with a TAMIS procedure, resulted in the successful closure of the fistula. Although a standardized gold standard has yet to be established, this case suggests that a staged and comprehensive approach may be a promising avenue for addressing the challenging complications associated with prostatic interventions. Further research and exploration of similar multidisciplinary interventions are warranted to refine treatment protocols and improve outcomes in RUF cases.