Surgical video case: Iatrogenic rectourinary fistula (RUF) following radical prostatectomy is a rare complication and often becomes refractory 1-3. The symptoms, such as urinary drainage from anus or faecaluria, deteriorate their quality of life significantly. They often result in permanent double diversion with suprapubic catheterization and enterostomy. Although a variety of surgical procedures has been attempted to treat this type of fistula4-8, none of them has been accepted as a universal standard. Transanal endoscopic microsurgery (TEM), invented by Buess9, was originally aimed at complete en-bloc resection of rectal tumors and closure of the full-thickness defect by suturing. Its application for fistula closure has been reported by a few authors including our team10-13. After the previous report12, we modified the repair technique to try to improve the success rate. Herein we demonstrate our new method of repair performed by TEM, which we name “overlapping rectal muscle plasty” and report the clinical outcomes of 15 patients.
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