Transperineal approach to complex rectourinary fistulae.

Area of Science:

• Urology
• Surgical Oncology
• Reconstructive Surgery

Background:

• Complex rectourethral fistulae (RUF) present significant reconstructive challenges.
• Prior radiation, failed repairs, and large fistula size (>2 cm) define complex RUF.

Purpose of the Study:

• To evaluate the experience and outcomes of transperineal repair with gracilis muscle flap interposition for complex RUF.
• To assess the efficacy and safety of this surgical technique.

Main Methods:

• Retrospective review of 10 patients with complex RUF between July 2009 and November 2013.
• Seven patients meeting inclusion criteria underwent transperineal repair with gracilis flap.
• Exclusion of three patients due to the need for urinary diversion for large defects.

Main Results:

• Six of seven patients had a history of prostate cancer; one had colon cancer.
• Mean fistula size was 2.8 cm; no recurrences were observed at a mean follow-up of 11.4 months.
• Complications included stress urinary incontinence (5/7), wound infection (1/7), and pulmonary embolism (1/7).

Conclusions:

• Transperineal repair with gracilis muscle interposition is an effective treatment for complex RUF.
• The procedure demonstrates low morbidity and high success rates.
• Stress incontinence and bladder outlet contracture are common sequelae requiring further management.