Innovative application of locally vascularized pedicled fat pad interposition in rectourethral fistula repair

Rectourethral fistula (RUF) is a rare condition with significant therapeutic challenges and no standardized management. Surgical repair is one of the treatment options for RUF, where tissue interposition improves overall surgical outcomes for complex fistulas. We report an innovative approach in a patient with traumatic RUF secondary to a vehicular accident. Despite multiple surgeries over a 20-year course, the patient continued to experience urine leakage per anus during voiding. After separate suture of the rectal and urethral fistula opening, a locally vascularized pedicled fat pad was interposed. Short-term follow-up demonstrated favorable surgical outcomes.