Excision primary anastomosis urethroplasty with gracilis muscle flap for management of complex stricture with prostatorectal fistula and failure of multiple surgeries: A case report

Complex urethral strictures are challenging to manage, particularly after failed urethroplasty and associated complications. We report a case of a 32-year-old male with a nine-year history of urinary retention following pelvic trauma and six prior surgeries, including an iatrogenic prostatorectal fistula. The patient underwent re-do excision and primary anastomotic (EPA) urethroplasty combined with gracilis muscle flap interposition for fistula repair. Inferior pubectomy and bulbar urethra transection were performed. Postoperative recovery was uneventful, and uroflowmetry showed satisfactory flow (Qmax: 14.8 mL/s). EPA urethroplasty with gracilis flap may improve outcomes in complex urethral stricture with fistula.