Perineal subcutaneous dartos pedicled flap as a new technique for repairing urethrorectal fistula.

PURPOSE: Urethrorectal fistulas are rare, and the etiology is usually traumatic or iatrogenic (postoperative). Several operative approaches and techniques have been used for fistulous repair but no procedure has proved to be the best or universally acceptable. We present a new technique for repairing urethrorectal fistulas.

MATERIALS AND METHODS: We successfully treated 12 male patients 7 to 65 years old who presented with urethrorectal fistula from 1990 to 1997 using the perineal subcutaneous dartos pedicled flap procedure. Urethrorectal fistulas resulted from crush pelvic injury in 6 cases and gunshot in 2, and developed after prostatectomy in 4. The fistula was associated with urethral stricture in 4 cases. A perineal approach was used in all cases of urethrorectal fistula and combined with the transsymphyseal approach in the 4 patients with posterior urethral stricture. We interposed a subcutaneous dartos pedicled flap as a vascularized tissue flap between the repaired rectum and urethra.

RESULTS: The results of our technique were excellent in all cases. No leakage or perineal collection developed and there was no fistula recurrence. In 1 patient urethral stricture was managed by visual internal urethrotomy. Loss of the internal and external sphincters resulted in urinary incontinence in 4 cases, involving gunshot injury (2), crush pelvic injury (1) and prostatectomy (1). Followup ranged from 9 to 42 months.

CONCLUSIONS: Our technique of a perineal subcutaneous dartos pedicled flap fulfills all principles of the successful repair of urethrorectal fistula. We consider it to be an ideal solution to this urological dilemma.