Recto-urinary fistula (RUF) treated by transanal endoscopic microsurgery (TEM). Review of the literature and surgical technique

Introduction. Acquired Rectourinary Fistula is often caused by major surgery. Different techniques and approaches are reported but there is no definitive treatment: Transanal Endoscopic Microsurgery allows to operate with a magnified and tridimensional vision and offers the advantage of being less invasive. Materials and Methods Discussion. The ideal treatment should ensure correct hemostastis and provide for carring out the sutures on healthy tissue with adequate vascularization, less inflamed tissue and a tension free suture line. The minimally invasive approach should be pursued with the goal of reducing morbidity and mortality; from 1983 to now 17 cases of TEM-assisted fistulas treatment are reported in literature with only four recurrences. TEM gives great results even in patients who have already undergone previous surgical attempts. Conlusions. TEM-assisted procedure is an alternative to traditional methods and offers the advantages of operating in a three-dimensional field, with fewer blood loss and less complications; unfortunately, in the treatment of patients irradiated shares with other approaches to the same problems and the same results.