Choice of different tissue flaps in the treatment of urethro-rectal fistulas associated with urethral strictures

Abstract

Objective To evaluate the clinical efficacy of different tissue flaps interposition in reconstructing urethra-rectal fistulas associated with posterior urethral strictures. Methods Twenty-nine patients with urethra-rectal fistulas associated with posterior urethral strictures (15 patients after traffic accident trauma, 9 after falling injury, and 5 after pelvic crush injury) were included in this study. Trans-perineal urethral reconstruction and fistula repair with perineal subcutaneous dartos pedicled flap transposition was performed in 15 patients in whom fistulas were near the anus (<5 cm) and the perineal subcutaneous tissues were rich in blood supply. An interposition gracilis muscle flap was placed in 14 patients with fistulas located farther from the anus (≥5cm) or poor perineal local tissue condition. Results After a mean follow-up of 24.5 months (5-67 months), successful repair was achieved in 12 of 15 patients (80.0%) undergoing perineal subcutaneous dartos pedicled flap transposition, and in 11 of 14 patients (78.6%) undergoing gracilis muscle transposition. The overall success rate was 79.3%. No long-term procedure related complications occurred except medial thigh numbness in 1 patient. Conclusions The perineal subcutaneous dartos pedicled flap is suitable for hypervascular and low-positioned urethra-rectal fistulas located less than 5 cm from the anus. For patients with high-positioned fistulas or poor perineal local tissue conditions, the gracilis muscle flap is recommended. The technique of vascularized tissue pedicled flap transposition is essential for urethra-rectal fistula repair. Key words: Urethra-rectal fistula; Urethral stricture; Surgery; Tissue flap