Complex strictures - Recto Urethral Fistula

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Those patients who present with penetrating trauma to the rectum usually need immediate repair of the rectal tear wound and a covering colostomy.  Associated pelvic fracture urethral injury will need an open or trocar supra pubic cystostomy. Once the patient is stabilized he is discharged home and comes back three months later for step two i.e. anastomotic urethroplasty omental wrap. The approached used is the TW perineo abdominal progression approach. Through the perineal incision the bulbar urethra is dissected and transected inferior pubectomy is performed if required. The surgeon inserts his left index finger into the rectum and attempt is made to close the tear in the rectum. Many times, it is not possible to close this whole but if we perform a proper anastomotic urethroplasty and wrap omentum or the Gracilis muscle between the rectum and urethra the results are excellent. Once the patient is voiding well after catheter removal the colostomy is closed three months after the second step.