Re: Short- and Long-Term Complications and Outcomes of Radiation and Surgically Induced Rectourethral Fistula Repair with Buccal Mucosa Graft and Muscle Interposition Flap

2017 ◽  
Vol 198 (1) ◽  
pp. 148-149
Author(s):  
Allen F. Morey
Keyword(s):  
Buccal Mucosa ◽  
Rectourethral Fistula ◽  
Fistula Repair ◽  
Buccal Mucosa Graft ◽  
Short And Long Term ◽  
Surgically Induced ◽  
Interposition Flap

Short- and Long-term Complications and Outcomes of Radiation and Surgically Induced Rectourethral Fistula Repair With Buccal Mucosa Graft and Muscle Interposition Flap

Urology ◽  
2016 ◽  
Vol 98 ◽  
pp. 170-175 ◽  
Author(s):  
Daniel A. Kaufman ◽  
Leonard N. Zinman ◽  
Jill C. Buckley ◽  
Peter Marcello ◽  
Brendan M. Browne ◽  
...  
Keyword(s):  
Buccal Mucosa ◽  
Rectourethral Fistula ◽  
Fistula Repair ◽  
Buccal Mucosa Graft ◽  
Short And Long Term ◽  
Surgically Induced ◽  
Interposition Flap

scholarly journals Urethroplasty with dorsal buccal mucosa graft. Is it still the method of choice in long term urethral stenosis?

2017 ◽  
Vol 89 (1) ◽  
pp. 42 ◽  
Author(s):  
Carlo Pavone ◽  
Dario Fontana ◽  
Ninfa Giacalone ◽  
Nino Dispensa ◽  
Marco Vella ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Buccal Mucosa ◽  
Maximum Flow ◽  
Screening Tests ◽  
Life Questionnaire ◽  
Urethral Stenosis ◽  
Buccal Mucosa Graft

The aim of our work was to evaluate the long-term changes in symptoms (median 42 months) and to analyze data for any negative predictive factors for the application of the procedure, in patients who underwent to urethroplasty with dorsal buccal mucosa graft. During the period from 2010 to 2015 27 patients were examined. Than they underwent urethroplasty using dorsal buccal mucosa graft (graft of 4 x 2.5 cm). The evaluation of symptoms has been addressed through the application of the IPSS Quality of Life Questionnaire (International Prostatic Symptoms Score) and the evaluation of urinary flow has been carried out by a comparative analysis between the pre- and post-operative uroflowmetry. As our study has shown, data obtained by the screening tests in the post-operative follow-up indicate that there is an increase in the maximum flow of urine until 1 month after surgery. The results in the long-term follow-up are different because they show a partial reduction of the maximum flow although it is maintained around an average value of 23 ml/s being still higher than the maximum flow in the pre-operative period. According to our results it follows that there is a low failure rate of the procedure after a median of 42 months. Only in patients with urethral stenosis longer than 2 cm, a lower long term success is achieved. From what we could observe, this length of the stenosis seems to be the only negative predictive factor for long-term maintenance of a good Quality of Life in patients undergoing the procedure. The results obtained from our study confirm literature data according to which, the gold standard for 2-cm long bulbar urethral stricture whose lumen is well preserved with circumferential spongiofibrosis limited to 1-2 mm is the dorsal graft urethroplasty with buccal mucosa that in our study showed success rates higher of 80% after a median follow up of 42 months and a percentage of relapse-free patients of 82.1% ( median 3.5 years).

Long-term Artificial Urinary Sphincter Outcomes Following a Prior Rectourethral Fistula Repair

Urology ◽  
2015 ◽  
Vol 86 (3) ◽  
pp. 608-612 ◽  
Author(s):  
John Patrick Selph ◽  
Ramiro Madden-Fuentes ◽  
Andrew C. Peterson ◽  
George D. Webster ◽  
Aaron C. Lentz
Keyword(s):  
Artificial Urinary Sphincter ◽  
Rectourethral Fistula ◽  
Fistula Repair ◽  
Urinary Sphincter

scholarly journals Case Report: Use of reinforced buccal mucosa graft over gracilis muscle flap in management of post high intensity focused ultrasound (HIFU) rectourethral fistula

F1000Research ◽  
2017 ◽  
Vol 5 ◽  
pp. 2891 ◽  
Author(s):  
Shrikant Jai ◽  
Arvind Ganpule ◽  
Abhishek Singh ◽  
Mohankumar Vijaykumar ◽  
Vinod Bopaiah ◽  
...  
Keyword(s):  
Case Report ◽  
Buccal Mucosa ◽  
Focused Ultrasound ◽  
Muscle Flap ◽  
Gracilis Muscle ◽  
High Intensity Focused Ultrasound ◽  
Rectourethral Fistula ◽  
Gracilis Muscle Flap ◽  
Buccal Mucosa Graft ◽  
Free Closure

High intensity focused ultrasound (HIFU) has come forward as alternative treatment for carcinoma of the prostate. Though minimally invasive,HIFUhas potential side effects. Urethrorectal fistula is one such rare side effect. Management of these fistulas has been described by Vanni et al. This case report describes points of technique that will help successful management of resilient rectourethral fistula. Urinary and faecal diversion in the form of suprapubic catheter and colostomy is vital. Adequate time between stoma formation, fistula closure and then finally stoma closure is needed. Lithotomy position and perineal approach gives best exposure to the fistula. The rectum should be dissected 2cm above the fistula; this aids in tension free closure of the rectal defect. Similarly buccal mucosal graft was used on the urethra to achieve tension free closure. A good vascular pedicle gracilis muscle flap is used to interpose between the two repairs. This not only provides a physical barrier but also provides a vascular bed for BMG uptake. Perfect haemostasis is essential, as any collection may become a site of infection thus compromising results.  We strongly recommend rectourethral fistula be directly repaired with gracilis muscle flap with reinforced buccal mucosa graft without attempting any less invasive repairs because the “first chance is the best chance”.

V1830: Complex Radiation Rectourethral Fistula Repair with Buccal Mucosal Patch Graft and Gracilis Muscle Interposition Flap

2007 ◽  
Vol 177 (4S) ◽  
pp. 608-608
Author(s):  
David Canes ◽  
John T. Stoffel ◽  
John J. Murray ◽  
Peter W. Marcello ◽  
Leonard N. Zinman
Keyword(s):  
Gracilis Muscle ◽  
Rectourethral Fistula ◽  
Fistula Repair ◽  
Patch Graft ◽  
Interposition Flap

scholarly journals Case Report: Use of reinforced buccal mucosa graft over gracilis muscle flap in management of post high intensity focused ultrasound (HIFU) rectourethral fistula

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2891
Author(s):  
Shrikant Jai ◽  
Arvind Ganpule ◽  
Abhishek Singh ◽  
Mohankumar Vijaykumar ◽  
Vinod Bopaiah ◽  
...  
Keyword(s):  
Case Report ◽  
Buccal Mucosa ◽  
Focused Ultrasound ◽  
Muscle Flap ◽  
Gracilis Muscle ◽  
High Intensity Focused Ultrasound ◽  
Rectourethral Fistula ◽  
Gracilis Muscle Flap ◽  
Buccal Mucosa Graft ◽  
Free Closure

High intensity focused ultrasound (HIFU) has come forward as alternative treatment for carcinoma of the prostate. Though minimally invasive,HIFUhas potential side effects. Urethrorectal fistula is one such rare side effect. To our knowledge this is first case in which rectourethral fistula secondary to HIFU was repaired with buccal mucosa graft (BMG) over a harvest bed of gracilis flap. This case report describes points of technique that will help successful management of resilient rectourethral fistula. Urinary and faecal diversion in the form of suprapubic catheter and colostomy is vital. Adequate time between stoma formation, fistula closure and then finally stoma closure is needed. Lithotomy position and perineal approach gives best exposure to the fistula. The rectum should be dissected 2cm above the fistula; this aids in tension free closure of the rectal defect. Similarly buccal mucosal graft was used on the urethra to achieve tension free closure. A good vascular pedicle gracilis muscle flap is used to interpose between the two repairs. This not only provides a physical barrier but also provides a vascular bed for BMG uptake. Perfect haemostasis is essential, as any collection may become a site of infection thus compromising results.  We strongly recommend rectourethral fistula be directly repaired with gracilis muscle flap with reinforced buccal mucosa graft without attempting any less invasive repairs because the “first chance is the best chance”.

Sign in / Sign up

Export Citation Format

Share Document