Rectourethral Fistula (RUF) Procedure

Lahey physicians have coauthored two research articles recently published in highly respected medical journals that address new hope for men suffering from a devastating complication of prostate cancer treatment, among other causes.

The complication is called a rectourethral fistula (RUF), a condition in which an opening forms between the urethra, through which urine passes on its way out of the body, and the rectum. In men with a RUF, urine leaks from the rectum and cannot be controlled.

RUF can develop after prostate removal surgery (prostatectomy) or radiation therapy to treat prostate cancer. It can also happen from infection, inflammatory bowel disease, and a tumor within the pelvis. Until fairly recently, reconstruction of RUFs was fairly successful after prostate surgery but usually was unsuccessful in cases where the RUF was a complication of radiation therapy.

In one of the articles, Lahey urologists Alex J. Vanni, MD, and Leonard N. Zinman, MD – along with their coauthors, Lahey colon and rectal surgeon Peter W. Marcello, MD, Lahey urology residents Daniel A. Kaufman, MD, and Brendan M. Browne, MD, and former Lahey urologist Jill C. Buckley, MD – studied short-term and long-term complications and outcomes of RUF repair with a special technique perfected at Lahey that involves taking a graft from a patient’s mouth and muscle flap from a patient’s leg.

Lahey researchers first published articles about this technique about seven years ago. “We changed the course and outcome of this repair with innovation that includes using a muscle flap in the leg and a graft from the patient’s inner mouth,” Dr. Zinman explained. “We reported successful RUF closure in 98% of surgical patients and in 86% of patients who had radiation. Truthfully, it’s an outcome that had no precedent.”

Dr. Vanni said the collaborative environment at Lahey, including the combined efforts in this research by urology and colon and rectal specialists, has contributed to the hospital’s success in RUF repair. “Our data show nearly every fistula can be fixed with a relatively low complication rate,” he said.

In the second article, Drs. Zinman and Vanni collaborated with seven other researchers to study only RUFs that occur from prostate cancer treatment. They studied 201 patients over 15 years at Lahey Hospital & Medical Center, the University of California San Francisco, University College London Hospitals, and Devine-Jordan Center for Reconstructive Surgery.

The researchers examined the types of prostate cancer treatment, technical aspects of the RUF repair, and outcomes. They concluded that this type of RUF can be successfully treated even in complex cases, reporting ultimate success rates for fistula repair of 87% in men who had radiation therapy and 99% in men who had prostate removal surgery.