Gracilis Muscle Flap for Treatment of Rectourinary Fistula and Urethrocutaneous Fistula
Keywords:
Gracilis Muscle Flap, Rectourinary Fistula, Urethrocutaneous FistulaAbstract
Introduction and Objective: Rectourinary fistula is uncommon and urethrocutaneous fistula from urethral cancer is rare. Several procedures have been described for management of these fistulas. The aim of this study was to present the experience with gracilis muscle flap in the treatment of lower urinary tract fistula.
Material and Method: A retrospective chart review of 5 male patients (age 23-58 years) who underwent the operation using gracilis muscle flap for treatment urinary fistula during January 1997- January 2007. One patient with urethrocutaneous fistula was from urethral cancer, two patients with rectourethral fistula were from pelvic fracture. Two patients with rectovesical fistula, were from perirectal abscess and pelvic fracture. The latter four patients with rectourinary fistula, all had colostomy and suprapubic cystostomy before definite treatment, two patients had previous failed attempts to repair the fistula and one patient had fecal incontinence from anal sphincter injury.
Result: One patient with urethrocutaneous fistula from urethral cancer underwent total pelvic ex- enteration and closure perineal defect with gracilis myocutaneous flap and the patient died 1 year after the operation. Four patients with rectourinary fistula underwent transperineal repair fistula with gracilis muscle flap interposition. One patient with concomitant complete urethral stricture was repaired using preputial skin flap urethroplasty and one patient with anal incontinence had anal sphincter repaired and using gracilis muscle to create an encirclement of the anus. All four patients had successful closure of urinary fistula and all diverting colostomy were closed later. The patient with anal incontinence had good fecal control.
Conclusion: This result suggests that gracilis muscle flap is useful and effective treatment for rectourinary fistula and closure perineal defect.
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