Vesicorectal Fistula

Vesicorectal fistula is one of the most devastating postoperative complications after radical prostatectomy. Definitive treatment is difficult due to morbidity and recurrence.Various surgical and non-surgical approaches have been described, each with varying degrees of success and associated risks. Conservative management, including bladder drainage and bowel rest, may be considered initially to allow for spontaneous closure, particularly in cases with small fistulas and minimal symptoms. However, this approach is often unsuccessful in achieving definitive closure. Surgical interventions range from local fistula repair with tissue interposition to more complex reconstructive procedures involving the use of vascularized tissue flaps, such as gracilis or omental flaps, to improve tissue healing and reduce the risk of recurrence. Robotic-assisted laparoscopic techniques have also emerged as a minimally invasive alternative for vesicorectal fistula repair, offering potential benefits such as reduced blood loss, shorter hospital stay, and improved cosmesis. Despite advancements in surgical techniques, the management of vesicorectal fistula remains challenging, and a multidisciplinary approach involving urologists, colorectal surgeons, and radiologists is crucial for optimal patient outcomes.