Five patients with recurrent rectourinary fistula as postoperative complication of pull through procedure for anorectal anomaly were presented. In four patients, the initial surgery was perpormed at the other institution and the accurate classification of the lesion was not avail-able. They were all complicated with urinary discharge from the anus, starting at one month to two years after the initial operation. The rectourinary fistula was located at 3cm proximal to anal mucocutaneous junction in four cases. Proctoscopic observation of the fistula orifice was possible in these cases. They were all successfully treated by direct closure of the fistula through perineal approach. A creation of the colostomy was indicated in one patient for severe perineal erosion. In one patient, a sacroperineal pull through operation had been performed for rectourethral fistula at our institute. Anterior wall of the rectum was injured longitudinally at division of th rectourethral fistula, which was closed carefully in two layers. Postoperatively the urine examination revealed positive E. coli repeatedly. A urethrogram revealed a recurrent rectouri-nary fistula at rather proximal portion comparing to the other four cases. A endorectal pull through procedure was successfully performed for this case. By the experience of these five cases, the authors have concluded as follows: 1) Cause of the recurrent rectourinary fistula: (1) Wrong pull through procedure without recognition of the presenting fistula (in two). (2) Anterior rectal wall injury (in one). (3) Intra and/or postoperative injury of the urethra caused by bougie (suspected in two cases). 2) Treatment of recurrent rectourinary fistula: (1) Perineal closure of the fistula is indicated for low type fistula. Pull through of the anterior wall of the rectum over the site of the fistura is important. Colostomyis not always nescessary. (2) Endorectal pull through is indicated for high type fistula.
