Repair of recto-urethral fistula with urethral augmentation by buccal mucosal graft and gracilis muscle flap interposition – our experience

INTRODUCTION: Recto-urethral fistula (RUF) is a relatively rare surgical condition, the treatment of which is quite challenging. There are many causes of RUF, but 60% of them are iatrogenic following open prostatectomies, radiotherapy, brachytherapy, urethral instrumentation etc. We present a series of six cases treated at our institution. MATERIAL AND METHODS: A retrospective study of all six patients with recto-urethral fistula treated at our centre between 2011 and 2016 was performed. The study included charting of information like age, etiology, clinical presentation, diagnostic modalities, treatment protocols, complications and recurrence. All the patients had simple direct fistulas with no previous history of repair. One patient had history of pelvic fracture following road traffic accident, one patient had a penetrating perineal injury following road traffic accident; two patients had history of Freyer's prostatectomy for benign prostatic hypertrophy; two patients had history of open radical prostatectomy performed at other centres. All patients were treated with an initial double diversion (suprapubic cystostomy and colostomy) followed by definitive surgical repair three months later. The surgical technique used was fistula excision, urethral augmentation by buccal mucosal graft, primary rectal defect repair and gracilis muscle flap interposition between the rectum and urethra. RESULTS: The patients were followed up ranging from after 6 to 48 months with a mean follow-up period of 27 months. There were minimal complications such as main wound site infections, seroma at the harvested site of gracilis muscle flap, urethral stricture. There was no report of recurrence. CONCLUSIONS: From our experience, we conclude that this method of repair is a very efficient one without any recurrence and with minimal complications. The results were on par with all the other successful methods of recto-urethral fistula repair described in the literature.