Iatrogenic recto-urethral fistula: perineal repair and buccal mucosa interposition.
OBJECTIVE
To present a new and promising technique for repairing recto-urethral fistulae (RUF) using a perineal approach and buccal mucosa graft interposition, as RUF are rare but severe complications of rectal or urinary tract surgery, radiation treatment, trauma or inflammation, and the repair of recurrent or persistent RUF is particularly difficult when previous surgical attempts have failed, resulting in high recurrence rates.


METHODS
Between 2004 and 2006, five men (aged 61-67 years) with iatrogenic RUF had the perineal fistula closed using a buccal mucosa graft interposition. The RUF had developed after laparoscopic or retropubic radical prostatectomy in four patients and after radical cystectomy and ileal neobladder in the fifth. Four of the patients had had at least one failed RUF repair before their referral to our institution.


RESULTS
Four of the five RUF were repaired successfully using the perineal approach and buccal mucosa graft interposition. Failure occurred in one patient who had developed a RUF after laparoscopic radical prostatectomy followed by two unsuccessful attempts at closure. The failure was most probably due to a previously undetected postoperative perineal haematoma with infection.


CONCLUSIONS
Our perineal approach for repairing RUF, combined with buccal mucosa graft interposition, is a simple technique fulfilling all the requirements for successful fistula closure, especially in repeat surgery.
Spahn
Martin
M
Department of Urology and Paediatric Urology, Julius Maximilians University Medical School, Würzburg, Germany.
Vergho
Daniel
D
Riedmiller
Hubertus
H
D000368:Aged; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D010502:Perineum; D011183:Postoperative Complications / Q000209:etiology; D012003:Rectal Fistula / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000150:complications / Q000601:surgery*; D014548:Urinary Fistula / Q000150:complications / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*