Recurrent Congenital Rectourethral Fistula Repair Using Gracilis Muscle Flap Interposition

Aim: Congenital rectourethral fistulas are rare and poses a difficult surgical challenge. Fistula between the lower rectum and the urethra due to congenital cause associated with the constellation of pelvic floor malformation. Although symptoms such as pneumaturia, faecaluria, and the passage of urine through the rectum are often alleviated by faecal and urinary diversion, these fistulas seldom spontaneously heal. Even when diverted, patients may suffer from urinary tract infections, resistant to the medical therapy. Thus, most of these patients will eventually require surgical treatment. Methods: Two patients with RUF at age of 16 and 21 years who underwent multiple (2 and 7) unsuccessful reconstructive attempts were referred to our department. The repair was performed with gracilis muscle flap interposition through perineal approach. All these two patients had colostomy and suprapubic cystostomy prior to definitive surgical repair to 6 months before. 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. Results: The follow up periods of the two patients were eight and ten months. All the patients have been dry and continent. The colostomy and suprapubic cystotomy were closed in these two patients after five months. Conclusion: The gracilis muscle flap interposition is a viable treatment option for congenital RUF. The flap is rotated easily into the perineum, brings vascularized muscle to operated site and is a mechanical barrier between the urethra and rectum. It is associated with low morbidity and a high success rate.