Transperineal repair with bulbocavernosus muscle interposition for recto‐urethral fistula

Ganio, Edward A.; Martina, S.; Novelli, Eugenio; Sandru, R.; Clerico, Giuseppe; Luc, A. Realis; Trompetto, Mario

doi:10.1111/codi.12091

Cited by 8 publications

(4 citation statements)

References 23 publications

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“…Various tissue flaps can be interposed between the repaired urethra and rectum [ 11 – 13 ], but the gracilis muscle flap was utilized in over 95% of cases using the transperineal approach [ 5 ]. This muscle has been associated with a high success rate of 70–90% [ 14 ], regular blood supply, easy mobilization [ 10 ], and healthy tissue outside the irradiation field even after radiation therapy for prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

Post-traumatic rectourethral fistula in an adolescent managed via a transperineal approach using a local gluteal tissue interposition flap: a case report

et al. 2021

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Background Rectourethral fistula is a rare disease with a wide variety of etiologies and clinical presentations. A definitive surgical procedure for rectourethral fistula repair has not been established. Case presentation A 13-year-old boy sustained a penetrating injury to the perineum, and developed a symptomatic rectourethral fistula thereafter. Conservative management through urinary diversion and transanal repair was unsuccessful. Fecal diversion with loop colostomy was performed, and three months later, a fistula repair was performed via a transperineal approach with interposition of a local gluteal tissue flap. There were no postoperative complications, and magnetic resonance imaging studies confirmed the successful closure of the fistula. The urinary and fecal diversions were reverted 1 and 6 months after the fistula repair, respectively, and postoperative excretory system complications did not occur. Conclusions The transperineal approach with interposition of a local gluteal tissue flap provides a viable surgical option for adolescent patients with rectourethral fistulas who are unresponsive to conservative management.

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Section: Discussionmentioning

confidence: 99%

Post-traumatic rectourethral fistula in an adolescent managed via a transperineal approach using a local gluteal tissue interposition flap: a case report

et al. 2021

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“…In our center, we usually perform a graciloplasty, according to our personal surgical experience, but in the literature, other sorts of interposition flaps (i.e. bulbocavernosus muscle) have been described with good results [22]. Transabdominal repairs usually entail greater omental and peritoneal flaps.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of acquired rectourethral fistula: a retrospective analysis of 52 consecutive patients

et al. 2020

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Background Acquired rectourethral fistula (RUF) is an uncommon complication mostly resulting from surgery or radiation. Standardization of the surgical management is lacking. The aim of this study was to report our experience with surgery for RUF. Methods This was a retrospective study of a prospectively maintained clinical database. The surgical strategy was tailored to complexity of RUF, presence of sepsis, history of radiation and residual urinary/fecal functionality. Outcomes measured were RUF closure and permanent fecal/urinary diversion. Impact of radiotherapy was also assessed. Results Between November 2002 and January 2019, 52 patients were identified (100% males). Median follow-up was 10.5 (0.5-16.8) years. Three patients had RUF closure after conservative management. The remaining 49 patients had a total of 76 procedures. The cumulative closure rate after the first, second and third attempt was 55.1%, 85.7% and 95.9%, respectively. Fistula closure together with preservation of the fecal and urinary function was achieved in 49%, 65.3% and 67.3% after the first, second and third repair, respectively. The overall success rate for transanal, transperineal, restorative transabdominal and non-restorative transabdominal procedures was 35.7%, 64.3%, 57.1% and 94.1%, respectively. A significantly higher rate of urinary/intestinal stomas was observed in the irradiated vs non-irradiated patients (84.2% vs 42.4%; p = 0.004). Conclusions Surgery ensured healing in 96% of the patients. Radiotherapy led to higher rate of permanent urinary/fecal diversion. Nearly all irradiated patients who had transabdominal repair end up with a definitive stoma. When transperineal repair with gracilis flap interposition was used, the rate of fistula closure approached 90%. A treatment algorithm is proposed.

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“…Si asportano i bordi della fistola. Il difetto uretrale viene quindi riparato in strato singolo e quello rettale in doppio strato con punti staccati (12). Durante questo approccio, al fine di ridurre il rischio di recidiva, è possibile interporre un tessuto quale muscolo bulbocavernoso o gracile.…”

Section: Introduzioneunclassified

Surgical Treatment of Rectourinary Fistulas: Review of the Literature

Crestani

Moro

2015

Urologia

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Transperineal repair with bulbocavernosus muscle interposition for recto‐urethral fistula

Cited by 8 publications

References 23 publications

Post-traumatic rectourethral fistula in an adolescent managed via a transperineal approach using a local gluteal tissue interposition flap: a case report

Post-traumatic rectourethral fistula in an adolescent managed via a transperineal approach using a local gluteal tissue interposition flap: a case report

Surgical management of acquired rectourethral fistula: a retrospective analysis of 52 consecutive patients

Surgical Treatment of Rectourinary Fistulas: Review of the Literature

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