Perineal subcutaneous dartos pedicled flap as a new technique for repairing urethrorectal fistula.

PURPOSE: Urethrorectal fistulas are rare, and the etiology is usually traumatic or iatrogenic (postoperative). Several operative approaches and techniques have been used for fistulous repair but no procedure has proved to be the best or universally acceptable. We present a new technique for repairing urethrorectal fistulas. MATERIALS AND METHODS: We successfully treated 12 male patients 7 to 65 years old who presented with urethrorectal fistula from 1990 to 1997 using the perineal subcutaneous dartos pedicled flap procedure. Urethrorectal fistulas resulted from crush pelvic injury in 6 cases and gunshot in 2, and developed after prostatectomy in 4. The fistula was associated with urethral stricture in 4 cases. A perineal approach was used in all cases of urethrorectal fistula and combined with the transsymphyseal approach in the 4 patients with posterior urethral stricture. We interposed a subcutaneous dartos pedicled flap as a vascularized tissue flap between the repaired rectum and urethra. RESULTS: The results of our technique were excellent in all cases. No leakage or perineal collection developed and there was no fistula recurrence. In 1 patient urethral stricture was managed by visual internal urethrotomy. Loss of the internal and external sphincters resulted in urinary incontinence in 4 cases, involving gunshot injury (2), crush pelvic injury (1) and prostatectomy (1). Followup ranged from 9 to 42 months. CONCLUSIONS: Our technique of a perineal subcutaneous dartos pedicled flap fulfills all principles of the successful repair of urethrorectal fistula. We consider it to be an ideal solution to this urological dilemma.

[Treatment of stenoses of the penile urethra by urethroplasty with dorsal pedicled patch: roofing urethroplasty]. / Traitement des sténoses de l'urètre pénien par urétroplastie avec patch pédiculé dorsal: "Urétroplastie en toit".

OBJECTIVE: Treatment of long or multiple anterior urethral stricture(s) when Monseur technique is not applicable. Our technique entails augmentation of the dorsally slit open stenosed urethra using pedicled non-hair bearing penile skin. PATIENTS AND METHODS: Between June 1991 and May 1996, 26 men (median age 34 years) with anterior urethral strictures underwent roofing urethroplasty. Nine patients had long stricture (average 3.2 cm) and 17 had multiple short segment strictures (average 7 cm). All patients were circumcised, and dorsal urethral augmentation was performed using transversely oriented non-hair bearing penile skin pedicled flap. RESULTS: Median follow-up was 38 months (range 3-50). A successful outcome with no recurrent stricture as evidenced by normal retrograde urethrography and voiding history was achieved in 23 of 26 men (88%). Two patients had fistula in early postoperative period; one of them needed surgical closure. CONCLUSION: Roofing urethroplasty is a practical alternative for repair of long anterior urethral stricture(s) when Monseur technique cannot be applied.

The use of buccal mucosa patch graft in the management of anterior urethral strictures.

We describe our experience with 20 patients undergoing 1-stage correction of an anterior urethral stricture using a buccal mucosa patch graft. This technique was used for treatment of short strictures (1 to 2 cm.) that usually required a 2 to 4 cm. repair, making excision and end-to-end anastomosis impractical. Results were excellent in 18 patients, while 2 required revision for recurrent stricture. Urethrocutaneous fistulas and diverticulas were not encountered in our series. The buccal mucosa patch graft is hairless and, therefore, it can tolerate trauma and infection adequately. This technique represents a reasonable alternative when penile skin cannot be used or endoscopic manipulation is not indicated.