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Under the present methods for the surgical treatment of urethrorectal fistulas about 25 per cent, of the cases terminate successfully. This low rate of recoveries is not surprising when it is remembered that the urethra is a curved channel carrying water under pressure and that the fistula is usually located at the most tortuous part. In addition to this, the rectum is in close apposition to the prostate and the recto-urethralis muscle anchors the ampulla of the rectum at a short distance from the membranous urethra.
The standard operative procedures seem faulty in principle. No one would try to repair a leak in the retaining wall of an irrigation ditch, especially on a curve, by tearing down the sound, natural wall for some distance close to and up into the leak, if this could be repaired in the line of leakage. Still, this is the principle underlying the operative methods
VIKO E. SURGICAL TREATMENT OF URETHRORECTAL FISTULAS. JAMA. 1914;LXII(14):1083-1084. doi:10.1001/jama.1914.02560390023010