title: Short- and Long-term Complications and Outcomes of Radiation and Surgically Induced Rectourethral Fistula Repair With Buccal Mucosa Graft and Muscle Interposition Flap.
abstract: OBJECTIVE
  To analyze and report 30-day, 90-day, and long-term complications and surgical outcomes over a 17-year period for anterior transperineal repair of rectourethral fistulas (RUFs) resulting from pelvic radiation and surgery.
  
  
  METHODS
  We performed a retrospective review of patients undergoing RUF repair between January 1, 1998 and February 28, 2015, at a single institution. All RUF were repaired using an anterior transperineal approach with an interposition muscle flap and selective use of a buccal mucosa graft onlay.
  
  
  RESULTS
  Ninety-eight patients underwent repair with an anterior transperineal approach and muscle interposition flap (49 non-radiation induced and 49 radiation or ablation induced). Thirty- and 90-day complication rates were 29% and 2%, respectively, for non-radiated RUF, and 29% and 24%, respectively, for radiated RUF. Urethral diverticula, urinary incontinence, urethral stricture, and bowel problems were delayed complications requiring surgery. At a median follow-up of 14.5 months (range 3-144), 98% (48 of 49) of non-radiated RUF were closed with 1 procedure, whereas 86% (42 of 49) of radiated RUF were closed with 1 procedure. Gastrointestinal tract continuity was restored in 94% (45 of 48) of non-radiated RUF and in 65% (30 of 46) of radiated RUF.
  
  
  CONCLUSIONS
  Successful RUF closure is possible in 98% of non-radiated and in 86% of radiated or ablated patients with 1 procedure. Most radiation-induced RUF, regardless of size, can be successfully repaired with minimal short-term complications. Delayed complications may arise and require surgery, and thus continued surveillance is recommended.
authors.affiliation: Institute of Urology, Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Kaufman
authors.affiliation: Institute of Urology, Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Zinman
authors.affiliation: Department of Urology, University of California San Diego Medical Center, San Diego, CA.
authors.forename: Jill C
authors.initials: JC
authors.lastname: Buckley
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Peter
authors.initials: P
authors.lastname: Marcello
authors.affiliation: Institute of Urology, Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Browne
authors.affiliation: Institute of Urology, Lahey Hospital and Medical Center, Burlington, MA. Electronic address: alex.vanni@lahey.org.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Vanni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D000071976:Gracilis Muscle / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D011183:Postoperative Complications; D011471:Prostatic Neoplasms / Q000628:therapy; D011832:Radiation Injuries / Q000150:complications* / Q000175:diagnosis; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012003:Rectal Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors; D014548:Urinary Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D014567:Urography; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects