title: Rectourethral fistula associated with two short segment urethral strictures in the anterior and posterior urethra: single-stage reconstruction using buccal mucosa and a radial forearm fasciocutaneous free flap.
abstract: BACKGROUND
  We report a novel surgical technique used to repair a rectourethral fistula associated with two short-segment urethral strictures located in the anterior and posterior segments of the urethra in a patient with prior unsuccessful repairs.
  
  
  METHODS
  The anterior urethral stricture was reconstructed with a ventral onlay of buccal mucosa in the exaggerated lithotomy position. In a modified prone position, the rectourethral fistula was repaired using the transrectal transsphincteric (York-Mason) technique and the posterior urethral stricture with a radial forearm fasciocutaneous free flap which was anastomosed to the inferior gluteal artery and vein. The coexistence of a rectourethral fistula and distal urethral stricture requires simultaneous repair, because the urethral pressure from the distal obstruction may compromise fistula closure. Reconstructive efforts should be tailored to minimize disruption of the urethral blood supply in patients with previous pelvic trauma. Rectal and urethral repairs should be separated by well-vascularized tissue to prevent fistula recurrence.
  
  
  CONCLUSIONS
  The radial fasciocutaneous flap may offer the reconstructive surgeon another surgical option for complex urethral stricture and rectourethral fistula reconstruction when the local blood supply is in question. Longer follow-up and more cases are needed to further evaluate the continued use of this technique.
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. b-erickson@md.northwestern.edu
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Erickson
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Dumanian
authors.forename: Mark
authors.initials: M
authors.lastname: Sisco
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Jang
authors.forename: Amy L
authors.initials: AL
authors.lastname: Halverson
authors.forename: Chris M
authors.initials: CM
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D009061:Mouth Mucosa / Q000637:transplantation*; D012003:Rectal Fistula / Q000150:complications / Q000601:surgery*; D013524:Surgical Flaps; D014522:Urethral Diseases / Q000150:complications / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D014548:Urinary Fistula / Q000150:complications / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods