Complex urinary fistulas in children: repair with gracilis muscle flap interposition
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v83i3.963Keywords:
Children, urinary fistula, surgical flapAbstract
Case description: Two complex urinary fistulas were repaired in two pediatric patients using gracilis muscle flap interposition. A 12 year-old girl with cloacal exstrophy and urethral fistula secondary to a cervicourethral disconnection, and a 12 year-old boy with previous vesicoprostatic rhabdomyosarcoma and rectourethral fistula.
Relevance: Gracilis muscle flap interposition is frequently used in adults to repair urinary fistulas, with a success of 70-90%. In pediatric patients, there is limited literature reporting results of this technique.
Clinical implications: We consider that the use of gracilis muscle flap to repair urinary fistulas in children is feasible, being a safe technique with good short-term results.
Conclusions: Gracilis muscle flap interposition should be considered as a surgical option in the treatment of complex urinary fistulas in children.
References
Huang X, Tan SS, Chen Y, Li T. Acquired Rectourethral and Rectovaginal Fistulas in Children: A Systematic Review. Frontiers in Pediatrics. 2021;9. https://doi.org/10.3389/fped.2021.657251
Cerdán Santacruz C, Cerdán Miguel J. Fístulas recto-uretrales adquiridas: etiopatogenia, diagnóstico y opciones terapéuticas. Cirugía Española. 2015 Mar;93(3):137–46. doi: https://doi.org/10.1016/j.ciresp.2014.10.005
Ulrich D, Roos J, Jakse G, Pallua N. Gracilis muscle interposition for the treatment of recto-urethral and rectovaginal fistulas: a retrospective analysis of 35 cases. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2009;62(3):352–6. doi: https://doi.org/10.1016/j.bjps.2008.11.067
Muñoz-Duyos A, Navarro-Luna A, Pardo-Aranda F, Caballero JM, Borrat P, Maristany C, et al. Gracilis Muscle Interposition for Rectourethral Fistula After Laparoscopic Prostatectomy: A Prospective Evaluation and Long-term Follow-up. Diseases of the Colon & Rectum. 2017;60(4):393–8. doi: https://doi.org/10.1097/dcr.0000000000000763
Zmora O, Tulchinsky H, Gur E, Goldman G, Klausner JM, Rabau M. Gracilis Muscle Transposition for Fistulas Between the Rectum and Urethra or Vagina. Diseases of the Colon & Rectum. 2006;49(9):1316–21. doi: https://doi.org/10.1007/s10350-006-0585-3
Hechenbleikner EM, Buckley JC, Wick EC. Acquired Rectourethral Fistulas in Adults: A Systematic Review of Surgical Repair Techniques and Outcomes. Diseases of the Colon & Rectum. 2013;56(3):374–83. doi: https://doi.org/10.1097/dcr.0b013e318274dc87
Ghoniem G, Elmissiry M, Weiss E, Langford C, Abdelwahab H, Wexner S. Transperineal Repair of Complex Rectourethral Fistula Using Gracilis Muscle Flap Interposition—Can Urinary and Bowel Functions be Preserved? Journal of Urology. 2008;179(5):1882–6. doi: https://doi.org/10.1016/j.juro.2008.01.021
González-Contreras QH, Bahena-Aponte JA, Salinas-Aragón E, Jiménez-González A, González-Longoria G. Interposición de músculo grácil para reparar fístula rectouretral. Informe de un caso. Cir Cir. 2011;79(4):371–3.
Zmora O, Potenti FM, Wexner SD, Pikarsky AJ, Efron JE, Nogueras JJ, et al. Gracilis muscle transposition for iatrogenic rectourethral fistula. Ann Surg. 2003;237(4):483–7. doi: https://doi.org/10.1097/01.sla.0000059970.82125.db
Takano S, Boutros M, Wexner SD. Gracilis Muscle Transposition for Complex Perineal Fistulas and Sinuses: A Systematic Literature Review of Surgical Outcomes. Journal of the American College of Surgeons. 2014;219(2):313–23. doi: https://doi.org/10.1016/j.jamcollsurg.2014.04.006
Nerli RB, Koura A, Prabha V, Patne P, Devaraju S, Amarkhed SS, et al. Acquired recto-urethral fistula in children: Long-term follow-up. Journal of Pediatric Urology. 2009;5(6):485–9. doi: https://doi.org/10.1016/j.jpurol.2009.03.001
Liu G-C, Xia H-M, Wen Y-Q, Zhang L-Y, Li Z-M. Considerations before repair of acquired rectourethral and urethrovaginal fistulas in children. World J Pediatr. 2008;4(1):53–7. doi: https://doi.org/10.1007/s12519-008-0011-0
Nikolaev VV. Recurrent rectourethral fistula repair: A novel technique of gracilis muscle interposition. Journal of Pediatric Surgery. 2020;55(9):1974–8. doi: https://doi.org/10.1016/j.jpedsurg.2020.05.028
