The Uroplastic Approach to Complex Rectourethral Fistula Repair: Indications, Technique, Results.

Area of Science:

• Urology
• Plastic Surgery
• Surgical Reconstruction

Background:

• Rectourethral fistulae present complex challenges requiring multidisciplinary care.
• The specific indications and techniques for gracilis muscle interposition in fistula repair are not well-defined.

Purpose of the Study:

• To investigate the outcomes of rectourethral fistula management before and after implementing a multidisciplinary treatment algorithm.
• To further analyze patients with complex fistulae undergoing gracilis muscle flap interposition.

Main Methods:

• Retrospective quasi-experimental study of 23 patients undergoing gracilis muscle flap interposition (2001-2022).
• Plastic surgery involvement was indicated for specific sizes of radiated and non-radiated fistulae.
• Detailed description of the gracilis muscle flap harvest, transposition, and inset technique.

Main Results:

• The frequency of definitive rectourethral fistula healing improved by 33% after algorithm implementation.
• No significant difference was observed in fistula healing time or diversion reversal rates.
• The technique of gracilis muscle flap interposition was detailed.

Conclusions:

• Gracilis muscle interposition flap is a valuable reconstructive option for complex rectourethral fistulae.
• A multidisciplinary treatment algorithm, including plastic surgery, improved definitive healing rates.