Choice of different tissue flaps in the treatment of urethro-rectal fistulas associated with urethral strictures / 中华泌尿外科杂志

ABSTRACT

Objective To evaluate the clinical efficacy of different tissue flaps interposition in reconstructing urethra-rectal fistulas associated with posterior urethral strictures.Methods Twenty-nine patients with urethra-rectal fistulas associated with posterior urethral strictures (15 patients after traffic accident trauma,9 after falling injury,and 5 after pelvic crush injury) were included in this study.Transperineal urethral reconstruction and fistula repair with perineal subcutaneous dartos pedicled flap transposition was performed in 15 patients in whom fistulas were near the anus (＜ 5 cm) and the perineal subcutaneous tissues were rich in blood supply.An interposition gracilis muscle flap was placed in 14 patients with fistulas located farther from the anus (≥Scm) or poor perineal local tissue condition.Results After a mean follow-up of 24.5 months (5-67 months),successful repair was achieved in 12 of 15 patients (80.0％) undergoing perineal subcutaneous dartos pedicled flap transposition,and in 11 of 14 patients (78.6％) undergoing gracilis muscle transposition.The overall success rate was 79.3％.No longterm procedure related complications occurred except medial thigh numbness in 1 patient.Conclusions The perineal subcutaneous dartos pedicled flap is suitable for hypervascular and low-positioned urethra-rectal fistulas located less than 5 cm from the anus.For patients with high-positioned fistulas or poor perineal local tissue conditions,the gracilis muscle flap is recommended.The technique of vascularized tissue pedicled flap transposition is essential for urethra-rectal fistula repair.