title: Surgical treatment of 31 complex traumatic posterior urethral strictures associated with urethrorectal fistulas.
abstract: BACKGROUND
  Urethrorectal fistulas (URF) in patients with complex posterior urethral strictures are rare and difficult to repair surgically. There is no widely accepted standard approach described in the published literature.
  
  
  OBJECTIVE
  The aim of this study was to describe the outcomes of various operative approaches for the repair of URFs in patients with complex posterior urethral strictures.
  
  
  METHODS
  From January 1985 to December 2007, 31 patients (age: 6-61 yr; mean: 28.4) with URFs secondary to posterior urethral strictures were treated using a perineal or combined abdominal transpubic-perineal approach.
  
  
  METHODS
  A simple perineal approach was used in 4 patients; a transperineal inferior pubectomy approach was used in 18 patients; and a combined transpubic-perineal approach was used in 9 patients. A bulbospongiosus muscle and subcutaneous dartos pedicle flaps were interposed between the repaired rectum and urethra in 22 patients. The combined transpubic-perineal approach used either a gracilis muscle flap (one patient) or a rectus muscle flap (eight patients).
  
  
  METHODS
  Suprapubic catheterisation was used for bladder drainage, and a urethral silicone stent was left indwelling for 4 wk.
  
  
  CONCLUSIONS
  One-stage repair was successful in 4 patients (100%) using the perineal approach, in 16 of 18 patients (88.9%) using the transperineal-inferior pubectomy approach, and in 7 of 9 patients (77.8%) using the transpubic-perineal approach. Recurrent urethral strictures developed in two cases; one patient required regular dilation, and the other patient was treated successfully with tubed perineoscrotal flap urethroplasty. Recurrent URFs developed in two additional patients.
  
  
  CONCLUSIONS
  Surgical approaches for the treatment of URFs associated with complex urethral strictures should be based on a number of considerations including the location of the URF, its aetiology, the length of the urethral strictures, and a history of previous unsuccessful repairs. These results demonstrate that the transperineal-inferior pubic approach may be appropriate as a first-line procedure.
authors.affiliation: Department of Urology, Sixth People's Hospital, Jiaotong University of Shanghai, Shanghai 200233, People's Republic of China. xuyuemin@263.net
authors.forename: Yue-Min
authors.initials: YM
authors.lastname: Xu
authors.forename: Ying-Long
authors.initials: YL
authors.lastname: Sa
authors.forename: Qiang
authors.initials: Q
authors.lastname: Fu
authors.forename: Jiong
authors.initials: J
authors.lastname: Zhang
authors.forename: San-Bao
authors.initials: SB
authors.lastname: Jin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D014521:Urethra / Q000293:injuries; D014522:Urethral Diseases / Q000150:complications / Q000601:surgery; D014525:Urethral Stricture / Q000150:complications / Q000209:etiology / Q000601:surgery*; D014548:Urinary Fistula / Q000150:complications / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D055815:Young Adult