Rectourethral fistula is a devastating condition occuring usually as a complication of radical prostatectomy or pelvic irradiation. Classical treatment requires surgical repair with derivation of the urine and stool with temporary cysto and colostomy.

We present four cases of sucessful endoscopic closure of rectourethral fistula using different endoscopic procedures.

First patient was presented to our department with rectourethral fistula as a complication of difficult urinar catheterisation. During the catheterisation, tip of the catheter was inadvertely pushed into the distal rectum and inflated baloon stayed there for 3 days. After the CT scan was done, urologist took out the catheter and placed percutanoeus cystostomy. We started closing the fistula in a three week period; first and second intervention consisted of argon plasma coagulation of the fistula edges and 2ml fibrin glue application, and durin the third intervention over-the scope clip 14/6 was placed and completely closed the fistula. Other three patients were presented to our hospital with the persistent fistula as a complication of radical prostatectomy. In one patient urologist already tried to close the fistule with two surgical procedures and the patient had cystostomy and sygmoidostomy but the fistulous tract persisted. Endoscopically fistula was located 3 cm orally from the anal verge with lumen of 3 mm; we performed three procedures with argon plasma coagulation of the edges, 2 ml fibrin glue and clip closure (tulip bunde techique twice, third time over the scope clip 14/6 application. After one month CT scan was done and revealed total fistula occlusion so cystostomy and sygmoidostomy were taken out. Third and fourth patients were presented immediately after prostatetctomy when fistula was detected (3 weeks after the surgery) so only one endoscopic intervention with argon plasma coagulation of the fistula edges, fibrin glue application and over-the scope clips 14/6 placement was enough in both patients to sucesfully close the fistulous tract.

With development of new endoscopic techniques, complex cases like refractory rectourethral fistula that usually required surgical treatment, can be adequately treated with minimally invasive endoscopic approach.