AUA 2017: Complex Bladder and Prostatic Urinary Fistulas

Boston, MA ( Dr Alex Vanni discussed the use of gracilis muscle interposition for radiation urinary fistula repair. Success rates for this repair is 86% compared to 50% with a York Mason technique, with fewer complications. He repairs the urethra with a buccal mucosa graft and then rotates in a gracilis flap. If there is significant dead space, he will use the contralateral gracilis flap as well. In his series only 8% required a urinary diversion for fistula recurrence, however 35% of patients did require a permanent fecal diversion.

Dr Angelo Gousse reported on the use of the York Mason trans-sphincteric, trans-rectal approach to recto-urethral fistulas. One of the most important steps of this technique is to identify and tag the sphincter of the rectum in order to preserve continence. Colostomy may not be necessary in non-radiated patients with a fistula that is less than 2 cm in size. For most patients with a history of radiation, he recommends using a perineal approach instead.

Dr Andrew Peterson finished the session by describing the role for supravesical diversion in this patient population. At Duke, the colovesical and urology departments have developed a multidisciplinary algorithm for patients with radiation-induced urinary fistulas. If the patient has a fistula that is less than two centimeters, they will use a perineal approach with a gracilis flap. If the fistula is greater than three centimeters, they use a pelvic exenteration and diversion.

Written By: Lisa Parrillo, MD, Genitourinary Reconstructive Surgery Fellow, University of Colorado

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA