Rectal flap advancement – a simple and effective approach for the treatment of rectourethral fistula

Abstract

Transanal rectal advancement flap is a simple and effective technique for the treatment of a rectourethral fistula with no need for urinary or faecal diversion.

Bilateral Puborectalis Interposition Repair of Rectourethral Fistula

“…these include the rectal sphincterpreserving transperineal approach, rectal mucosal advancement flap, anocutaneous advancement flap, dartos flap, gracilis muscle interposition procedures, and the posterior sagittal transrectal approach, also known as the York-mason technique. [6][7][8][9][10][11][12][13][14][15] the York-mason technique, through a posterior transsphincteric approach, offers good visibility and access to the rectourethral fistula in the mid rectum from the posterior approach after incising through the posterior wall of the anal sphincters and rectum. 6-8 its high success rates and the apparent ease of the technique are significant advantages.…”

“…[9][10][11][12][13][14][15] following the closure of the openings in the urethra and rectum, a vascularized flap such as the gracilis muscle can be interposed between the urethra and rectum. 9,10 although this technique has been associated with high success rates, it requires separate incisions along the thigh to harvest the gracilis muscle.…”

“…[1][2][3][4] several surgical approaches have been described in the management of rectourethral fistula. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] these approaches include transabdominal, abdominoperineal, transperineal, and transanal procedures. the fundamental principles lie with the disconnection of the fistula with possible…”

Rectourethral fistula following laparoscopic radical prostatectomy

“…A transanal or transperineal approach was used and all healed following 1 repair. Various surgical options are available to treat rectourethral fistula including transanal endorectal flap with or without biologic mesh reinforcement and transperineal repairs with the dartos or the gracilis interposition flap [3,8,[12][13][14][15][16][17][18][19][20][21][22]. Recently, advancement flap through a transanal endorectal microsurgery and closure after application of biologic glue have been described [23,24].…”

“…The choice of operation depends on the etiology and the morphology of the fistula. In the absence of prior radiation, most rectourethral fistulas can be approached with an endorectal advancement flap or a dartos flap [3,12,[14][15][16][17][18]. Large fistulas and those related to radiation therapy are best treated with transanal repair with biologic mesh or a gracilis interposition flap [13,19,22].…”