MP79-07 INDICATIONS FOR NOVEL INTERPOSITION MYOCUTANEOUS FLAP FOR THE REPAIR OF RECTO-URINARY FISTULA

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I1 Apr 2017MP79-07 INDICATIONS FOR NOVEL INTERPOSITION MYOCUTANEOUS FLAP FOR THE REPAIR OF RECTO-URINARY FISTULA Alyssa Greiman, Lawrence Dagrosa, Nima Baradaran, Eric Rovner, and Harry Clarke Alyssa GreimanAlyssa Greiman More articles by this author , Lawrence DagrosaLawrence Dagrosa More articles by this author , Nima BaradaranNima Baradaran More articles by this author , Eric RovnerEric Rovner More articles by this author , and Harry ClarkeHarry Clarke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2491AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recto-urinary fistula (RUF) is a rare complication following pelvic surgery, radiation or trauma. We report our experience using a perineal approach with a cremasteric myocutaneous interposition flap (CIF) for the treatment of symptomatic RUF and sought to compare their outcomes with patients undergoing repair with other interpositions. METHODS We identified all patients undergoing RUF repair at a single institution from January 2001 to June 2014. Demographics, fistula etiology, surgical approach and outcomes were reviewed. Successful RUF repair was defined based on a post-operative voiding cystourethrogram without evidence of contrast extravasation. RESULTS 26 patients underwent RUF repair by a single surgeon at our institution. All patients underwent colonic diversion prior to repair. Initial repair was performed at the median age of 63 (21-83) years using a cremasteric interposition flap (CIF) in 12 patients, gracilis interposition flap (GIF) in 13 and a rectus myocutaneos flap (RMF) in one. Median follow-up was 8.8 (1-44) months. Fistulas were categorized as complex where radiation therapy, salvage cryoablation or APR was performed (69.2%), and simple when they occurred in the setting of radical prostatectomy, hemorrhoidectomy or trauma (30.8%). Pre-repair hyperbaric oxygen was performed in 57.7% of patients and was not associated with improved success in initial closure for either complex or simple fistulas (p=0.16, 0.69). In the CIF group, 9 (75%) patients failed the initial repair with 2 subsequently undergoing successful second CIF, 4 with successful subsequent GIF and 2 lost to follow-up. One patient failed a repeat CIF. The majority of patients (88%) who failed initial repair with CIF had radiation-induced fistulas, whereas only 33% of patients with a successful initial repair had prior radiation exposure (p=0.12). In the GIF group, 11(84.6%) had successful repair with initial surgery. Initial repair of simple fistulas was more successful than complex fistulas (p=0.04). The use of GIF or rectus myocutaneous flap resulted in improved success in complex fistula repair as compared to CIF (p=0.004). There was no difference seen in success of simple fistula repair when comparing GIF and CIF (p=0.17). CONCLUSIONS Perineal repair of RUF using CIF is a novel approach with potentially less morbidity than larger muscle interposition flaps. However, the CIF is less effective in complex fistulas and thus should only be considered in patients with simple fistulas. For complex fistulas, a more vascularized flap such as GIF or rectus myocutaneous flap is effective. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1075 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Alyssa Greiman More articles by this author Lawrence Dagrosa More articles by this author Nima Baradaran More articles by this author Eric Rovner More articles by this author Harry Clarke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...