Transsphincteric Repair of Rectourethral Fistulas in Combination With Dartos Muscle Flap Interposition Following Radical Prostatectomy

Abstract

OBJECTIVETo present our experience with a novel technique that combines the York–Mason transsphincteric approach with dartos muscle flap interposition to treat rectourethral fistulas. METHODSWe extracted records from our prospectively kept database of 35 procedures conducted for treating rectourethral fistulas during 2002–2023; the York–Mason approach was combined with dartos muscle flap interposition in five cases, performed for treating rectourethral fistulas due to radical prostatectomy, all of which were referral cases. RESULTSAll five patients were successfully treated and followed up for a median of 70.0 months without recurrence. Before the fistula repair, all had a diverting stoma. In all cases, the first voiding cystourethrogram revealed a healed fistula. The posterior and the scrotal incisions healed uneventfully. All patients reported normal voiding and no urinary incontinence. To date, the stoma has closed in three patients, all of whom had intact fecal continence and no postoperative anal stenosis. CONCLUSIONThe transsphincteric modified York–Mason approach combined with dartos muscle flap interposition resulted in complete healing of rectourethral fistulas.