Case Report: Use of reinforced buccal mucosa graft over gracilis muscle flap in management of post high intensity focused ultrasound (HIFU) rectourethral fistula.
High intensity focused ultrasound (HIFU) has come forward as alternative treatment for carcinoma of the prostate. Though minimally invasive,HIFUhas potential side effects. Urethrorectal fistula is one such rare side effect. Management of these fistulas has been described by Vanniet al.This case report describes points of technique that will help successful management of resilient rectourethral fistula. Urinary and faecal diversion in the form of suprapubic catheter and colostomy is vital. Adequate time between stoma formation, fistula closure and then finally stoma closure is needed. Lithotomy position and perineal approach gives best exposure to the fistula. The rectum should be dissected 2cm above the fistula; this aids in tension free closure of the rectal defect. Similarly buccal mucosal graft was used on the urethra to achieve tension free closure. A good vascular pedicle gracilis muscle flap is used to interpose between the two repairs. This not only provides a physical barrier but also provides a vascular bed for BMG uptake. Perfect haemostasis is essential, as any collection may become a site of infection thus compromising results.  We strongly recommend rectourethral fistula be directly repaired with gracilis muscle flap with reinforced buccal mucosa graft without attempting any less invasive repairs because the "first chance is the best chance".
Dept. of Urology, Muljibhaipatel Urological Hospital, Gujarat, India.
Shrikant
0000-0001-6541-6283
S
Jai
Dept. of Urology, Muljibhaipatel Urological Hospital, Gujarat, India.
Arvind
0000-0003-2678-0634
A
Ganpule
Dept. of Urology, Muljibhaipatel Urological Hospital, Gujarat, India.
Abhishek
A
Singh
Dept. of Urology, Muljibhaipatel Urological Hospital, Gujarat, India.
Mohankumar
M
Vijaykumar
Staten Island University Hospital, Staten Island, USA.
Vinod
V
Bopaiah
Dept. of Urology, Muljibhaipatel Urological Hospital, Gujarat, India.
Ravindra
R
Sabnis
Dept. of Urology, Muljibhaipatel Urological Hospital, Gujarat, India.
Mahesh
M
Desai
Buccal Mucosa graft; Carcinoma Prostate.; Complicated Fistula; Fistula; Gracilis Muslce flap; HIFU; Urethro–rectal fistula