Background:Several studies have investigated the association between smoking and anal abscess and anal fistula (AA/F) diseases.However,the relationship between cigarette smoking and AA/F remains unclear.This study sought to assess the role of smoking in anorectal male patients in a Chinese population.Methods:In this retrospective study,a questionnaire,including smoking history,was completed over a 3-month period by male inpatients in the Proctology Department of China-Japan Friendship Hospital.Cases were patients who had AA/F,and controls were patients with other anorectal complaints.Mann-Whitney U-test and Chi-square test were carried out to examine differences in baseline characteristics between groups.Subsequently,multivariate logistic regression was used to explore any related factors.Results:A total of 977 patients aged from 18 to 80 years were included,excluding those diagnosed with inflammatory bowel disease or diabetes mellitus.Out of this total,805 patients (82.4％) completed the entire questionnaire.Among the 805 patients,334 (41.5％) were cases and 471 (58.5％) were controls.Results showed significant differences between cases and controls (x2 =205.2,P ＜ 0.001),with smoking found to be associated with the development of AA/F diseases (odds ratio:12.331,95％ confidence interval:8.364-18.179,P ＜ 0.001).Conclusions:This study suggested smoking to be a potential risk factor for the development of AA/F diseases in a Chinese population.Consequently,current smoking patients should be informed of this relationship,and further research should be conducted to explore and investigate this further.