Rectourethral fistula with combined bladder-neck and rectal injury after holmium laser enucleation of the prostate: staged multidisciplinary reconstruction

Rectourethral fistula after holmium laser enucleation of the prostate (HoLEP) is exceptionally rare. A man in his early 80s presented four days after HoLEP with urine per anus and fecal urethral catheter drainage. CT showed anterior rectal and bladder-base defects with pelvic collections. Emergency laparotomy achieved source control with bladder closure, suprapubic drainage, and colostomy. Persistent communication required staged bilateral nephrostomy diversion before robot-assisted fistula repair, rectal repair, and bladder-neck closure. Imaging confirmed closure and bowel continuity was restored, although suprapubic drainage remained definitive. Fistula, bowel, and urinary outcomes warrant separate reporting.