Repair of Rectourethral Fistula Using Gracilis Muscle Flap Interposition—a Tertiary Care Center Experience

Rectourethral fistula (RUF) is a rare surgical condition, the management of which remains a surgical challenge as is evident by the numerous procedures described in the literature; none of them gaining widespread acceptance. We describe our experience in the management of RUF using gracilis muscle flap interposition. This study is a case series analysis of three patients with RUF treated at our center between 2016 and 2020. The information recorded was etiology, clinical presentation, prior surgeries, diagnostic workup, operative details, complications, and follow-up. One patient had RUF following pelvic fracture, one developed RUF following multiple blind metallic dilations, while the third patient developed RUF following ether installation to rupture Foley’s catheter balloon. All the patients had double diversion in the form of suprapubic cystostomy and colostomy prior to definitive surgical repair to 6 months later. The surgical technique used was excision of the fistula and repair of the rectal and urethral defects with interposition of the right gracilis muscle flap. The operative times were 320, 300, and 210 min, and the blood loss was 400, 300, and 250 ml. One patient had a surgical site infection and one had hematoma at the flap harvest site which were managed accordingly. The follow-up periods for the three patients were 23, 45, and 49 months. All the patients have been dry and continent. Gracilis muscle flap interposition is a safe and viable approach in the management of difficult to deal RUFs with good outcomes and an acceptable morbidity profile.