Modification of the anterior perineal transanorectal approach for complicated prostatic urethrorectal fistula repair.

Rectoprostatic fistulas can pose challenging problems for surgical reconstruction. We describe and illustrate the successful repair of a difficult, post-traumatic prostatic urethrorectal fistula by combining use of a vascularized scrotal dartos flap interposition with a modified anterior rectal wall flap fistula repair (Park's technique). An anterior perineal transanorectal, transanorectal, transsphincteric approach provided excellent operative exposure as well as a direct path for the perineal pedicled dartos island flap en route to the fistula repair site.