Iranian Journal of Colorectal Research

Iranian Journal of Colorectal Research

Local tissue interposition flaps in the management of post-traumatic rectouretheral fistulae: a case series

Document Type : Case Report

Authors
Prasanna Ram 1
Prasant Nayak 1
Swarnendu Mandal 1
Manoj Kumar Das 1
Sambit Tripathy 2
1 Department of Urology and Renal Transplant All India Institute of Medical sciences, Bhubaneswar, India
2 Department of Urology and Renal Transplant, All India Institute of Medical Sciences, Bhubaneswar, India
10.30476/acrr.2023.98120.1170
Abstract
INTRODUCTION
Recto urethral fistula is relatively rare condition with worldwide incidence rates of less than 3%, and have a wide range of clinical presentations. Treatment involves surgical correction with various techniques described in literature. Here we look at a case series of complex recto urethral fistulae and their management involving local tissue flaps.

CASE PRESENTATION
Three patients with complex recto urethral fistulae underwent surgical repair with a pedicled gracilis muscle flap. All patients underwent a pelvic magnetic resonance scan and a flexible antegrade and retrograde cystoscopy prior to their repair. For two patients, the gracilis muscle flap was harvested from the left thigh and the right thigh for the third patient.


CONCLUSION:
Trauma and radiation are the two most common causes of recto urethral fistulae. Most of these patients have a poor quality of life and require surgical repair with some form tissue interposition. The failure of a prior RUF repair results in worsening of the patient’s quality of life and makes the subsequent surgery more challenging. Diversion of both the urine and faeces as the initial treatment results in better outcomes of the final repair, and hence should always be included in the management protocol of this rare entity.
Keywords
Rectourethral fistula
Gracilis flap
QOL
Management
Outcomes
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Iranian Journal of Colorectal Research
Volume 10, Issue 4
Autumn 2022
Pages 168-173