Gracilis Muscle Interposition Articles

Articles

  • Experience with 32 Pelvic Fracture Urethral Defects Associated with Urethrorectal Fistulas: Transperineal Urethroplasty with Gracilis Muscle Interposition

    PURPOSE:

    Pelvic fracture urethral defects associated with urethrorectal fistulas are rare and difficult to repair. The aim of this study was to evaluate the efficacy of transperineal urethroplasty with gracilis muscle interposition for the repair of pelvic fracture urethral defects associated with urethrorectal fistulas.

    MATERIALS AND METHODS:

    We identified 32 patients who underwent transperineal urethroplasty with gracilis muscle interposition to repair pelvic fracture urethral defects associated with urethrorectal fistulas. Patient demographics as well as preoperative, operative and postoperative data were obtained.

    RESULTS:

    Mean followup was 33 months (range 6 to 64). The overall success rate was 91% (29 of 32 cases). One-stage repair was successful in 17 of 18 patients (94%) using perineal anastomosis with separation of the corporeal body and in 12 of 14 (86%) using perineal anastomosis with inferior pubectomy and separation of the corporeal body. All 22 patients (100%) without a previous history of repair were successfully treated. However, only 7 of 10 patients (70%) with a previous history of failed urethroplasty and urethrorectal fistula repair were cured. Recurrent urethral strictures developed in 2 cases. One patient was treated successfully with optical internal urethrotomy and the other was treated successfully with tubed perineoscrotal flap urethroplasty. Recurrent urethrorectal fistulas associated with urethral strictures developed in an additional patient.

    CONCLUSIONS:

    Transperineal urethroplasty with gracilis muscle interposition is a safe and effective surgical procedure for most pelvic fracture urethral defects associated with urethrorectal fistulas. Several other factors may affect its postoperative efficiency.

    J Urol. 2017 Jul;198(1):141-147. doi: 10.1016/j.juro.2017.01.071. Epub 2017 Feb 1.

    Guo H1, Sa Y2, Fu Q1, Jin C1, Wang L1

    Author information

    1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
    2 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.

    Read an Expert Commentary by Zhamshid Okhunov, MD on this Abstract

    PubMedhttps://www.ncbi.nlm.nih.gov/pubmed/28161353




    Published September 18, 2017
  • The Place of Transanal Endoscopic Surgery in the Treatment of Recto-Urethral Fistula.

    To assess the role of TEO/TEM in recto-urethral fistulas (RUF). RUF may appear after radical prostatectomy. Their treatment represents a challenge; many therapies have been proposed, from conservative to aggressive surgical approaches.

    Published September 18, 2017
  • Transperineal Urethroplasty with Gracilis Muscle Interposition - Expert Commentary

    Pelvic fracture urethral defects (PFUDs) occur in around 10% of patients with pelvic fractures. PFUDs can sometimes be associated with urethrorectal fistulas and these have proven to be extremely difficult to operate on and repair. To date, there have not been any standardized approach to the treatment of complex PFUDs with associated URFs. Until now, surgeons have typically used various surgical approaches to repair these complex PFUDs such as utilizing various vascularized tissue flaps to interposition.
    Published September 18, 2017