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The study aimed to evaluate the surgical treatment of rectourethral fistula and to identify whether choice and results of treatment are influenced by radiotherapy.Patients, who underwent surgery for rectourethral fistula from January 1998 to January 2010 were identified. Their charts were reviewed and relevant demographics, history, surgery and follow up data were analyzed. An institutional review board approved the study. Statistical calculations were performed with JMP version 7 software, differences were considered significant between the groups when P value was < 0.05.Fifty-one patients underwent 57 repairs. 44 had one repair, five had two and one had three repairs. Thirty-four patients had abdominal surgery and 23 patients underwent a'perineal repair. Thirty-two patients hadpreviously been treated with radiotherapy. Abdominal surgery and nonreconstructive surgery were chosen significantly more often in irradiated patients (P < 0.001) and bowel and urinary stomas were closed significantly more often in non-irradiated patients (P < 0.001).Radiotherapy significantly influenced the choice and outcome of surgery for urethrorectal fistula.