TY  - EJOU
AU  - Yankelevich, Gabrielle 
AU  - Swaim, Jessica 
AU  - Coate, Ian 
AU  - Stroud, Margaret 
AU  - Stallings, William 
AU  - George, Virgilio 
AU  - Tavana, M. Lance 
AU  - Clarke, Harry 

TI  - Post-operative outcomes in rectourethral fistula repair using gracilis interposition flap
T2  - Canadian Journal of Urology

PY  - 2025
VL  - 32
IS  - 1
SN  - 1488-5581

AB  -  <b>Objectives:</b> To assess outcomes of rectourethral fistula repair utilizing a gracilis flap in a largely radiated cohort. <b>Patients and Methods:</b> 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. <b>Results:</b> 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 (<i>p</i> < 0.05). <b>Conclusions:</b> 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.
KW  - rectourethral fistula; fistula repair; gracilis flap; radiation; reconstruction

DO  - 10.32604/cju.2025.064684