Local Tissue Interposition Flaps in the Management of Post-traumatic Rectourethral Fistulae: A Case Series

Introduction: Rectourethral fistula is a relatively rare condition with a worldwide incidence rate of less than 3%, featuring a wide range of clinical presentations. Treatment mostly involves surgical correction via different techniques. Here, we look at a case series of complex rectourethral fistulae and their management involving local tissue flaps. Case Presentation: Three patients with complex rectourethral fistulae underwent surgical repair with pedicled gracilis muscle flaps. All patients underwent a pelvic magnetic resonance scan and a flexible antegrade and retrograde cystoscopy before their repair. The gracilis muscle flap was harvested from the left thigh in two patients and the right thigh in the third patient. Conclusion: Trauma and radiation are the two most common causes of rectourethral fistulae. Most of these patients have a poor quality of life and require surgical repair with some form of tissue interposition. The failure of a prior rectourethral fistula repair worsens the patient’s quality of life and makes the subsequent surgery more challenging. Diversion of both the urine and feces as the initial treatment results in better outcomes of the final repair and hence should always be included in the management protocol of this rare entity.