title: Treatment of urethrorectal fistulas caused by radical prostatectomy - two surgical techniques.
abstract: BACKGROUND
  The repair of complex urethrorectal fistulas, which can be the result of treating prostate cancer with radical prostatectomy, is a big problem in urology and its final result is not always satisfactory. There are no universally accepted methods for repairing such fistulas. In our work we present a retrospective analysis of patients treated for urethrorectal fistulas after previous radical prostatectomy. The methods used were the initial excision and suture of the fistula, or a gracilis muscle flap interposition.
  
  
  METHODS
  In the years 2000-2012, four patients were treated because of urethrorectal fistulas after radical prostatectomy. In two patients, open radical prostatectomy had been performed. Two other patients had been operated laparoscopically. Two patients had a primary fistula repair. They were operated using anterior perineal access. Two others were treated with the use of a gracilis muscle flap.
  
  
  RESULTS
  During the follow up, there was no recurrence of fistulas. Medium follow up for the first two patients was 120 and 156 months, and follow up of two other patients was 16 and 23 months. Until now, there were no final postoperative complications.
  
  
  CONCLUSIONS
  Repair of the fistulas requires an individual approach to each case. Excision and suturing of the fistula gives a very good final result, especially when the primary reconstruction is performed. Repair of urethrorectal fistula using a gracilis muscle flap appears to be an excellent option in cases of complex recurrent fistulas. It is also associated with low morbidity in patients and a high success rate.
authors: Department of Urology, Medical University of Gdańsk, Gdańsk, Poland.
authors: Wojciech
authors: W
authors: Polom
authors: Department of Urology, Medical University of Gdańsk, Gdańsk, Poland.
authors: Kazimierz
authors: K
authors: Krajka
authors: Karol Marcinkowski University of Medical Sciences, Św. Marii Magdaleny, Poznań, Poland.
authors: Tomasz
authors: T
authors: Fudalewski
authors: Department of Urology, Medical University of Gdańsk, Gdańsk, Poland.
authors: Marcin
authors: M
authors: Matuszewski
keywords: gracilis muscle; radical prostatectomy; surgical repair; urethrorectal fistulas