Preventing Rectourethral Fistula Recurrence With Gracilis Flap.

Area of Science:

• Urology
• Surgical Oncology
• Reconstructive Surgery

Background:

• Rectourethral fistula (RUF) is a rare but severe condition with diverse causes, including cancer, radiation, and surgery.
• Current treatments for RUF have high recurrence rates, and outcomes from previous studies on gracilis flap repair are varied and lack robust evidence.
• There is a need to evaluate the efficacy of gracilis flap in preventing RUF recurrence and identify associated risk factors.

Purpose of the Study:

• To compare the outcomes of rectourethral fistula repair with and without the use of a gracilis flap.
• To assess the efficacy of the gracilis flap in preventing fistula recurrence.
• To identify risk factors associated with rectourethral fistula recurrence.

Main Methods:

• A retrospective review of patients who underwent surgical repair for RUF between 2007 and 2018.
• Comparison of outcomes between patients who received gracilis flap repair and a control group.
• Logistic regression analysis to identify risk factors for recurrence.

Main Results:

• The gracilis flap group (n=24) showed a significantly lower recurrence rate (8%) compared to the control group (n=12, 50%; P=0.009).
• No significant differences were observed in hospitalization length or surgical complications between the groups.
• History of radiation and urinary incontinence were identified as risk factors for recurrence in the control group.

Conclusions:

• The use of a gracilis flap for rectourethral fistula repair is associated with a lower recurrence rate.
• Gracilis flap repair does not increase surgical complications.
• Gracilis flap reconstruction is recommended for RUF repair to improve outcomes.