Relapsing Urinary Tract Infection Due to Rectourethral Fistula in a Renal Transplant Recipient

Objectives: Urinary tract infection (UTI) is the most common cause of bacterial infection in renal transplant recipients. It occurs frequently in the early period because of the high-dose immunosuppressive agents and urethral catheterizations. Relapsing UTI may lead to graft dysfunction and further evaluations have to be performed for predisposing factors. We report the case of a renal transplant recipient who presented with relapsing bacterial UTI due to a rectourethral fistula. Case: A 24-year-old male patient underwent a successful renal transplantation from a living donor on May 2008. He had a history of surgical intervention for anal atresia and rectourethral fistula. He was hospitalized five times because of relapsing bacterial UTI after transplantation. We investigated the presence of an anatomical abnormality and found a rectourethral fistula. After the surgical repair of the fistula the UTI did not relapse. Conclusion: Relapsing infections are not uncommon and anatomical abnormalities can lead to relapsing UTI in transplant recipients. Further investigations must be performed regarding the factors that might contribute to the development of UTIs in the presence of relapsing UTI.