Rectourethral fistula is a complex condition which is disabling to the patient and frustrating to the surgeon. Several treatment options are available to treat it and the decision on the surgical approach depends on the etiology of the fistula and the expertise of the treating surgeon.

The following video illustrates the repair of a rectourethral fistula with gracilis flap and urethral reconstruction with buccal mucosal flap in a 65 year old man with history of prostate cancer, previously treated with seed implant and external beam radiation therapy. The patient had undergone both urinary and fecal diversion prior to the surgical repair. Buccal mucosa and the gracilis flap were harvested in the lithotomy position following which the patient underwent the reconstruction of his urethra and closure of the fistula in the prone jacknife position.

The fistula healed and subsequently the patient underwent closure of his colostomy.

Repair of rectourethral fistula with gracilis flap and urethral reconstruction with buccal mucosal flap is technically feasible and can eradicate the fistula.