alexa Transperineal repair of complex rectourethral fistula using gracilis muscle flap interposition--can urinary and bowel functions be preserved?
Surgery

Surgery

Medical & Surgical Urology

Author(s): Ghoniem G, Elmissiry M, Weiss E, Langford C, Abdelwahab H,

Abstract Share this page

Abstract PURPOSE: Rectourethral fistula developing after prostate cancer treatment is usually complex and difficult to repair. We present our experience with 25 cases of complex rectourethral fistula using gracilis muscle interposition, addressing the efficacy of this technique as well as the postoperative urinary and fecal outcome. MATERIALS AND METHODS: After receiving institutional review board approval we performed a retrospective chart review of patients with prostate cancer who had undergone gracilis muscle interposition for complex rectourethral fistula. A 1-page questionnaire was then mailed to all patients to assess urinary and bowel function. RESULTS: At mean followup of 28 months all patients had successful fistula closure with no recurrence. Of the 18 patients (72\%) with urinary continence 5 were continent after artificial urinary sphincter implantation. Three patients (12\%) were totally incontinent and lost to followup. Four patients (16\%) had permanent urinary diversion due to a devastated urinary outlet, while a urethral stricture was found in 5 and bladder neck contracture was noted in 3. Regarding bowel control, 19 patients (76\%) were continent, 2 (8\%) had fecal incontinence and 4 (16\%) required permanent colostomy due to a devastated fecal outlet. A total of 17 patients replied to the mailed questionnaire for a 68\% response rate and all had significant improvement in all parameters. Factors predisposing to a suboptimal outcome were large fistula size, surgery followed by radiation and cryotherapy. CONCLUSIONS: Gracilis muscle transposition is an excellent procedure for treating complex rectourethral fistula. Several other local factors may affect the postoperative urinary and fecal outcome. The collaboration of colorectal and urological surgeons is necessary to achieve optimal results. This article was published in J Urol and referenced in Medical & Surgical Urology

Relevant Expert PPTs

Recommended Conferences

Relevant Topics

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
adwords