Closure of rectourethral fistula
CPT4 code
Name of the Procedure:
Closure of Rectourethral Fistula
Common name(s): Rectourethral Fistula Repair
Summary
Closure of a rectourethral fistula is a surgical procedure to repair an abnormal connection between the rectum and the urethra. This procedure aims to restore the normal function of these organs and prevent infections and other complications.
Purpose
The procedure addresses the presence of a rectourethral fistula, which is an abnormal passageway between the rectum and the urethra. Goals include elimination of the fistula, prevention of recurrent infections, and restoration of normal urinary and bowel function.
Indications
- Recurrent urinary tract infections or prostatitis
- Passage of stool or gas through the urethra
- Urinary drainage from the rectum
- Pain or discomfort in the pelvic area
- Previous surgery, trauma, or radiotherapy causing the fistula
Preparation
- Fasting typically required 8 hours before the surgery.
- Adjustments to medications as instructed by the physician, especially blood thinners.
- Preoperative diagnostic tests such as a fistulogram, MRI, or CT scan.
- Bowel preparation may be prescribed to clean the intestines.
Procedure Description
- Anesthesia is administered, typically general anesthesia.
- A surgical approach is chosen based on fistula location and complexity (e.g., transperineal, transanal, or transabdominal).
- The fistula tract is identified and carefully dissected.
- The rectal and urethral openings are closed separately with sutures.
- Reinforcement with tissue flaps or muscle grafts may be used to ensure closure.
- Drains may be placed to prevent fluid accumulation.
- The incision is closed and dressed.
Duration
The procedure typically takes 2 to 4 hours, depending on the complexity.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Surgeon specialized in colorectal or urological surgery
- Anesthesiologist
- Surgical nurses
- Surgical technicians
Risks and Complications
- Infection at the surgical site
- Bleeding
- Recurrence of the fistula
- Injury to surrounding organs
- Urinary or fecal incontinence
- Anesthetic complications
Benefits
- Resolution of symptoms
- Improved quality of life
- Prevention of infections and other complications
- Restoration of normal urinary and bowel functions
Recovery
- Hospital stay for a few days post-surgery
- Pain management with prescribed medications
- Instructions on wound care and activity restrictions
- Follow-up appointments for monitoring healing
- Recovery period ranges from a few weeks to months, with gradual resumption of normal activities
Alternatives
- Temporary drainage or catheter placement to manage symptoms
- Non-surgical treatments if surgery poses high risks
- Conservative management may include antibiotics and stool softeners
- Comparison: Surgery typically offers a definitive solution. Alternatives may provide temporary relief but are less likely to result in permanent repair.
Patient Experience
- During the procedure: Anesthesia ensures the patient feels no pain.
- Post-procedure: Some pain and discomfort are expected. Pain management strategies will be in place.
- Gradual improvement in symptoms and normalization of functions.
- Potential need for temporary lifestyle adjustments for recovery enforcement.
Pain and comfort management include proper medications, support from healthcare team, and personalized care plans.