Open Access

ARTICLE

Post-operative outcomes in rectourethral fistula repair using gracilis interposition flap

Gabrielle Yankelevich^1,*, Jessica Swaim¹, Ian Coate¹, Margaret Stroud¹, William Stallings¹, Virgilio George², M. Lance Tavana³, Harry Clarke¹

1 Department of Urology, Medical University of South Carolina, Charleston, SC 29425, USA
2 Department of Colorectal Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
3 Department of Plastic Surgery, Medical University of South Carolina, Charleston, SC 29425, USA

* Corresponding Authors: Gabrielle Yankelevich. Email: ,

Canadian Journal of Urology 2025, 32(1), 37-42. https://doi.org/10.32604/cju.2025.064684

Received 23 June 2024; Accepted 10 January 2025; Issue published 20 March 2025

Abstract

Objectives: To assess outcomes of rectourethral fistula repair utilizing a gracilis flap in a largely radiated cohort. Patients and Methods: We performed a retrospective review of all gracilis interposition flap reconstruction surgeries performed for RUF at a university hospital in South Carolina between January 2010 and June 2023. All repairs utilized a multidisciplinary approach with urology, colorectal, and plastic surgery teams. Post-operatively, patients were maximally drained with foley catheter and suprapubic tube (SPT). Initial voiding cystourethrogram (VCUG) was performed at 4 weeks post-repair. If there was a persistent leak, catheter drainage was maintained for 4 additional weeks and VCUG was repeated. Success was defined as absence of leak on VCUG within 3 months after surgery. Results: 22 patients met inclusion criteria. 68% of patients had history of external beam radiation therapy (EBRT), 13.6% had brachytherapy, and 40.9% had cryotherapy. Initial post-operative VCUG was negative in 10 patients (45.5%). Of the 12 patients with a persistent fistula, 5 (42%) had no evidence of fistula on subsequent VCUG after 4 weeks. Overall, 68% of patients were successfully treated with gracilis interposition flap. There was a significant difference of repair success based on EBRT status (p < 0.05). Conclusions: We report a success rate of 68% for gracilis flap repair of RUF. Our cohort had a higher rate of prior radiation therapy compared to other studies. A clinically significant portion of patients with an initial positive VCUG will seal their fistula with prolonged catheter drainage. Gracilis interposition flap is a reasonable surgical treatment for RUF.

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Keywords

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