Local tissue interposition flaps in the management of post-traumatic rectouretheral fistulae: a case series

Abstract

INTRODUCTION Recto urethral fistula is relatively rare condition with worldwide incidence rates of less than 3%, and have a wide range of clinical presentations. Treatment involves surgical correction with various techniques described in literature. Here we look at a case series of complex recto urethral fistulae and their management involving local tissue flaps.CASE PRESENTATIONThree patients with complex recto urethral fistulae underwent surgical repair with a pedicled gracilis muscle flap. All patients underwent a pelvic magnetic resonance scan and a flexible antegrade and retrograde cystoscopy prior to their repair. For two patients, the gracilis muscle flap was harvested from the left thigh and the right thigh for the third patient. CONCLUSION: Trauma and radiation are the two most common causes of recto urethral fistulae. Most of these patients have a poor quality of life and require surgical repair with some form tissue interposition. The failure of a prior RUF repair results in worsening of the patient's quality of life and makes the subsequent surgery more challenging. Diversion of both the urine and faeces as the initial treatment results in better outcomes of the final repair, and hence should always be included in the management protocol of this rare entity.