Rectourethral fistula is a rare disease entity. In the adult population, the aetiology includes iatrogenic causes (radical prostatectomy or rectal surgery), trauma and inflammation. Because of its rarity, no single procedure has been universally adopted. We report a case of bulbar urethral-rectal fistula that presented 6 weeks following pelvic fractures with perianal abscess and subsequently, passage of urine per rectum. An initial 6-month period of faecal and urinary diversion was unsuccessful. Hence, he proceeded to definitive repair via a transperineal approach. The fistula tract was excised and the urethral defect closed over a urethral catheter. Bilateral dartos muscle flaps were then harvested on a pedicle (Fig. 1), and used to close the dead space between the bulbar urethra and rectum. The rectal defect was then closed by a mucosal advancement flap.
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