Skip to main content
Log in

Dartos Muscle Interposition Flap for the Treatment of Rectourethral Fistulas

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

Rectourethral fistula is a rare complication of pelvic surgery, trauma, or inflammation. The many techniques for repairing these fistulas vary in their success rates. Our goal was to describe the use of a dartos muscle interposition flap for repair of these fistulas.

Methods

We performed a retrospective review of eight patients who underwent repair of a rectourethral fistula with a dartos muscle interposition flap. We describe the success rate and patient-related factors that may have affected success. The technique of dartos muscle interposition is described and compared with other previously described techniques.

Results

Six of eight patients had healing of their fistulas documented by follow-up cystogram.

Conclusions

Dartos muscle interposition is a straightforward technique that can result in successful fistula repair but should not be used in patients with risk factors for poor wound healing, such as an immunocompromised state or previous radiation therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1

Similar content being viewed by others

References

  1. Gillitzer R, Melchior SW, Hampel C, Wiesner C, Fichtner J, Thuroff JW. Specific complications of radical perineal prostatectomy: a single institution study of more than 600 cases. J Urol 2004;172:124-.

    Article  PubMed  Google Scholar 

  2. Lev-Chelouche D, Margel D, Goldman G, Rabau MJ. Transanal endoscopic microsurgery: experience with 75 rectal neoplasms. Dis Colon Rectum 2000;43:662-.

    Article  CAS  PubMed  Google Scholar 

  3. McLaren RH, Barrett DM, Zincke H. Rectal injury occurring at radical retropubic prostatectomy for prostate cancer: etiology and treatment. Urology 1993;42:401-.

    Article  CAS  PubMed  Google Scholar 

  4. Munoz M, Nelson H, Harrington J, Tsiotos G, Devine R, Engen D. Management of acquired rectourinary fistulas: outcome according to cause. Dis Colon Rectum 1998;41:1230-.

    Article  CAS  PubMed  Google Scholar 

  5. Pieretti RV, Pieretti-Vanmarcke RV. Combined abdominal and posterior sagittal transrectal approach for the repair of rectourinary fistula resulting from a shotgun wound. Urology 1995;46:254-.

    Article  CAS  PubMed  Google Scholar 

  6. Chrouser KL, Leibovich BC, Sweat SD, et al. Urinary fistulas following external radiation or permanent brachytherapy for the treatment of prostate cancer. J Urol 2005;173:1953-.

    Article  PubMed  Google Scholar 

  7. Lane BR, Stein DE, Remzi FH, Strong SA, Fazio VW, Angermeier KW. Management of radiotherapy induced rectourethral fistula. J Urol 2006;175:1382-.

    Article  PubMed  Google Scholar 

  8. Santoro GA, Bucci L, Frizelle FA. Management of rectourethral fistulas in Crohn’s disease. Int J Colorectal Dis 1995;10:183-.

    Article  CAS  PubMed  Google Scholar 

  9. al-Ali M, Kashmoula D, Saoud IJ. Experience with 30 posttraumatic rectourethral fistulas: presentation of posterior transsphincteric anterior rectal wall advancement. J Urol 1997;158:421-.

    Article  CAS  PubMed  Google Scholar 

  10. Fengler SA, Abcarian H. The York Mason approach to repair of iatrogenic rectourinary fistulae. Am J Surg 1997;173:213-.

    Article  CAS  PubMed  Google Scholar 

  11. Garofalo TE, Delaney CP, Jones SM, Remzi FH, Fazio VW. Rectal advancement flap repair of rectourethral fistula: a 20-year experience. Dis Colon Rectum 2003;46:762-.

    Article  PubMed  Google Scholar 

  12. Noldus J, Fernandez S, Huland H. Rectourinary fistula repair using the Latzko technique. J Urol 1999;161:1518-0.

    Article  CAS  PubMed  Google Scholar 

  13. Nyam DC, Pemberton JH. Management of iatrogenic rectourethral fistula. Dis Colon Rectum 1999;42:994-.

    Article  CAS  PubMed  Google Scholar 

  14. Stephenson RA, Middleton RG. Repair of rectourinary fistulas using a posterior sagittal transanal transrectal (modified York-Mason) approach: an update. J Urol 1996;155:1989-1.

    Article  CAS  PubMed  Google Scholar 

  15. Visser BC, McAninch JW, Welton ML. Rectourethral fistulae: the perineal approach. J Am Coll Surg 2002;195:138-3.

    Article  PubMed  Google Scholar 

  16. Youssef AH, Fath-Alla M, El-Kassaby AW. Perineal subcutaneous dartos pedicled flap as a new technique for repairing urethrorectal fistula. J Urol 1999;161:1498-00.

    Article  CAS  PubMed  Google Scholar 

  17. Zmora O, Potenti FM, Wexner SD, et al. Gracilis muscle transposition for iatrogenic rectourethral fistula. Ann Surg 2003;237:483-.

    Article  PubMed  Google Scholar 

  18. Djordjevic ML, Perovic SV, Slavkovic Z, Djakovic N. Longitudinal dorsal dartos flap for prevention of fistula after a snodgrass hypospadias procedure. Eur Urol 2006;50:53-.

    Article  PubMed  Google Scholar 

  19. Kamal BA. Double dartos flaps in tubularized incised plate hypospadias repair. Urology 2005;66:1095-.

    Article  PubMed  Google Scholar 

  20. Furness PD 3rd, Hutcheson J. Successful hypospadias repair with ventral based vascular dartos pedicle for urethral coverage. J Urol 2003;169:1825-.

    Article  PubMed  Google Scholar 

  21. Venable DD. Modification of the anterior perineal transanorectal approach for complicated prostatic urethrorectal fistula repair. J Urol 1989;142:381-.

    CAS  PubMed  Google Scholar 

  22. Yamazaki Y, Yago R, Toma H. Dartos flap interposition in the surgical repair of rectourethral fistulas. Int J Urol 2001;8:564-.

    Article  CAS  PubMed  Google Scholar 

  23. Smith AM, Veenema RJ. Management of rectal injury and rectourethral fistulas following radical retropubic prostatectomy. J Urol 1972;108:778-.

    CAS  PubMed  Google Scholar 

  24. Goodwin WE, Turner RD, Winter CC. Rectourinary fistula: principles of management and a technique of surgical closure. J Urol 1958;80:246-4.

    CAS  PubMed  Google Scholar 

  25. Thompson IM, Marx AC. Conservative therapy of rectourethral fistula: five-year follow-up. Urology 1990;35:533-.

    Article  CAS  PubMed  Google Scholar 

  26. Renschler TD, Middleton RG. 30 years of experience with York-Mason repair of recto-urinary fistulas. J Urol 2003;170:1222-.

    Article  PubMed  Google Scholar 

  27. Wood TW, Middleton RG. Single-stage transrectal transsphincteric (modified York-Mason) repair of rectourinary fistulas. Urology 1990;35:27–30.

    Article  CAS  PubMed  Google Scholar 

  28. Wilbert DM, Buess G, Bichler KH. Combined endoscopic closure of rectourethral fistula. J Urol 1996;155:256-.

    Article  CAS  PubMed  Google Scholar 

  29. Vermaas M, Ferenschild FT, Hofer SO, Verhoef C, Eggermont AM, de Wilt JH. Primary and secondary reconstruction after surgery of the irradiated pelvis using a gracilis muscle flap transposition. Eur J Surg Oncol 2005;31:1000-.

    Article  CAS  PubMed  Google Scholar 

  30. Zmora O, Tulchinsky H, Gur E, Goldman G, Klausner JM, Rabau M. Gracilis muscle transposition for fistulas between the rectum and urethra or vagina. Dis Colon Rectum 2006;49:1316-1.

    Article  PubMed  Google Scholar 

  31. Ryan JA Jr, Beebe HG, Gibbons RP. Gracilis muscle flap for closure of rectourethral fistula. J Urol 1979;122:124-.

    PubMed  Google Scholar 

  32. Rius J, Nessim A, Nogueras JJ, Wexner SD. Gracilis transposition in complicated perianal fistula and unhealed perineal wounds in Crohn’s disease. Eur J Surg 2000;166:218-2.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Madhulika G. Varma M.D..

Additional information

Reprints are not available.

About this article

Cite this article

Varma, M.G., Wang, J.Y., Garcia-Aguilar, J. et al. Dartos Muscle Interposition Flap for the Treatment of Rectourethral Fistulas. Dis Colon Rectum 50, 1849–1855 (2007). https://doi.org/10.1007/s10350-007-9032-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-007-9032-3

Key words

Navigation