Rectourethral fistula (RUF) is a rare disease characterised by the abnormal connection between the urethra and the anus or rectum. It is uncommon but devastating to patients. It has a wide variety of etiologies and clinical presentations. RUF following Pelvic Fracture associated Urethral Injury (PFUI) is not uncommon. Spontaneous closure of the fistula is infrequent and most cases need surgical repair.

We here reported a patient with rectourethral fistula following a motor vehicle incident and sustained pelvic bone fracture and anal injury. Patient underwent a reconstructive surgery with a combination of urological and colorectal surgeons.

A 37-year-old gentleman involved in a motor vehicle accident in 2021 and sustained pelvic bone fracture with urethral injury and anorectal tear. Patient underwent diverting colostomy and suprapubic catheter insertion during the acute setting. After recovery, the patient complained of urine leak from anus. A cystogram showed rectourethral fistula. Flexible scope revealed fistula opening distal to the bladder neck. Patient underwent transperineal anastomotic urethroplasty combined fistula repair and anal sphincteroplasty in 2024. Post reconstructive surgery pericathetogram showed no contrast extravasation and the catheter was removed. At 3-month follow up, the patient was then able to pass urine well. No anal leakage or incontinence reported. Colorectal team to determine upon the reversal of colostomy later.

Rectourethral fistula represents a big challenge due to its rarity and complexity. There is to date no consensus on the optimal method of repair. A thorough preoperative evaluation taking into account the surrounding tissue viability and surgeon’s preference often determines the choice of procedure. Multiple surgical team corporations including urological, colorectal and plastic surgeons should be considered for the best interest of patients.