Rectourethral Fistula Symptoms, Causes, Treatment, ICD-10 & CPT Code

Fistulas are aberrant openings in the bowel or bladder. An opening between the rectum and the urethra, or urinary canal, is known as a recto-urethral fistula. This hole or opening causes urine to seep into the rectum and feces to enter the bladder.

Rectal-Urethral fistulas are complicated conditions that are also known as rectourethral or urethral-rectal fistulas. They can be brought on by rectal injuries sustained during radical prostatectomy or, more frequently, as an unwanted side effect of prostate radiation therapy. These issues become even more complicated and challenging when combined with urinary incontinence and urethral stricture condition.

Symptoms

The signs of rectourethral fistula can include air or gas bubbles in the urine, feces in the urine, chronic UTIs, localized discomfort, and urine leakage in the stool. Typically, the diagnosis requires direct visualization of the connection, injection of radiographic contrast into the area, or direct examination of the bladder and adjacent structures. It is a relatively uncommon condition, but it is one that needs immediate medical treatment because of its severity.

Causes

Both the recto-urethral fistula and the recto-bladder neck fistula are conditions that are only identified in male patients. Although there is no known cause for congenital anorectal malformations, environmental variables like drug use during pregnancy may contribute. Rectourethral fistula can be brought on by surgical procedures, radiotherapy, trauma, inflammation, and rarely anorectal anomalies.

Rectourethral fistula is a frequent side effect of prostate cancer treatment, particularly after surgery or radiation. Other reasons include infection, neoplasm, and rectal injuries sustained during radical prostatectomy. It is a relatively uncommon condition, but it is one that requires medical treatment because of its severity.

Treatment

In order to avoid infection and other problems, the initial goal of therapy for malformations involving the mixing of urine and feces is to direct the feces away from the urethra. This is done by creating a colostomy in the patient, and regardless of the patient's age, this procedure is carried out as soon as it is feasible after the condition is diagnosed in order to achieve the desired results.

A colostomy is a surgical procedure in which the final portion of the large intestine is rerouted through an incision in the abdominal wall and into a collection container outside of the body. If a colostomy is done soon after birth, phase 2 of treatment won't be done until the patient has had an opportunity to grow.

Depending on the exact type of fistula, the second stage of therapy will differ from patient to patient. During the operation, the urethra or bladder is disconnected from the rectum, and the rectum is lowered to form a new anal opening within the sphincter muscle complex. Laparoscopy is a minimally invasive technique that can be used for these procedures or a process known as posterior sagittal anorectoplasty (PSARP).

After the second procedure, feces will still exit the body through the colostomy for the following 6 to 8 weeks while the pull-through repairs. Following the healing of the pull-through, a third procedure will be carried out to close the colostomy so that feces can travel through the newly created anus.

Rectourethral Fistula ICD-10 Code

According to the WHO, urethral fistula is designated under the category of diseases of the genitourinary system with the ICD-10 code N36. 0.

Rectourethral Fistula CPT Code

Recto-urethral fistula repair is categorized by the CPT code 45820. This code is categorized as being part of the Repair Procedures for the Urethra range.