Low Residue Diet & Codeine May Substitute Faecal Diversion in Conservative Management of Patient with Rectourethral Fistula - A Case Report

Abstract

Aims: We present a patient that developed rectourethral fistula following prostatectomy for a misdiagnosed prostate cancer. He was managed conservatively without faecal diversion. Case Presentation: A 65 year old man presented to our hospital with a year history of lower urinary tract symptoms. He was evaluated and diagnosed to have BPH. Serum PSA was wrongly reported to be 0.9 ng/ml. He had open prostatectomy. On the 6th post-operative day, he developed faecaluria. Rectal examination revealed a fistula, admitting tip of the index finger. Histology revealed adenocarcinoma. He had bilateral total orchidectomy a week later, but refused surgical repair of the fistula and urinary or faecal diversion. He was maintained on urethral catheterization, low-residue diet and codeine. Discussion: The codeine and low residue diet made him constipated. Faecaluria stopped, fistula closed within 3 months. He however developed bladder neck contracture after a year. Conclusions: In some selected cases, low residue diet and the use of codeine can replace faecal diversion in managing rectourethral fistula; this can save the patient from the agony of having colostomy, only for the fistula to recur later.