Traumatic Urethro-Rectal Fistulas Associated with Pelvic Fractures: Diagnostic Approaches and Management Strategies

Urethro-rectal fistulas associated with pelvic fractures represent rare but devastating injuries that create abnormal communications between the urinary and gastrointestinal tracts. These complex injuries typically affect young male trauma patients and require a staged, multidisciplinary approach to management. This review examines epidemiology, pathophysiology, diagnostic workup, and management strategies for these injuries. Both conservative and surgical approaches are discussed, along with expected complications and long-term outcomes. While anatomical success rates are high with modern surgical techniques, functional outcomes remain challenging, with many patients experiencing erectile dysfunction and urinary incontinence. Current evidence suggests that a staged approach with initial diversion followed by delayed definitive repair optimizes outcomes for most patients. With comprehensive care, even patients with urethro-rectal fistulas in pelvic fracture can achieve meaningful recovery.