Abstract

Research Article

Minimally invasive gracilis muscle transposition: Initial report

Tobias Machado* and Anis Taha

Published: 23 April, 2020 | Volume 4 - Issue 1 | Pages: 017-018

Rectourethral fistula (RUF) is a divesting complication after prostate cancer treatment. The RUF incidence after radical prostatectomy is about 0.5% to 2%, [1,2]. Radiotherapy, criotherapy and high intensity focused ultrasound are other more severe causes [3,4].

Repair of RUF is a challenging surgical procedure. There are some possible approaches but transperineal is the most utilized.

In cases of complex fistulas interposition of muscle flaps between the rectum and urethra is highly recommended. Gracilis muscle transposition (GMT) is the preferred, due to excellent mobility and vascularization for perineal reconstruction [5,6]. Dissection of the gracilis muscle is done using one, 2 or 3 large incisions in the medial border of the thigh.

The aim of this report is present a new minimally invasive access to obtain a pediculate flap of gracilis muscle to interposition between bladder and rectum to treat RUF.

Read Full Article HTML DOI: 10.29328/journal.acst.1001016 Cite this Article Read Full Article PDF

Keywords:

Gracilis muscle; Urinary fistula; Minimally invasive surgery

References

  1. Mandel P, Linnemannstons A, Chun F, Schlomm T, Pompe R, et al. Incidence, Risk Factors, Management, and Complications of Rectal Injuries During Radical Prostatectomy. Eur Urol Focus. 2018;4: 554-557. Pubmed: https://www.ncbi.nlm.nih.gov/pubmed/28753847
  2. Hechenbleikner EM, Buckley JC, Wick EC. Acquired rectourethral fistulas in adults: a systematic review of surgical repair techniques and outcomes. Dis Colon Rectum. 2013; 56: 374-383. Pubmed: https://www.ncbi.nlm.nih.gov/pubmed/23392154
  3. Hanna JM, Turley R, Castleberry A, Hopkins T, Peterson AC, et al. Surgical management of complex rectourethral fistulas in irradiated and nonirradiated patients. Dis Colon Rectum. 2014;57: 1105-1112. Pubmed: https://www.ncbi.nlm.nih.gov/pubmed/25101607
  4. Chen S, Gao R, Li H, Wang K. Management of acquired rectourethral fistulas in adults. Asian J Urol. 2018; 5: 149-154. Pubmed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032817/
  5. Korsun S, Liebig-Hoerl G, Fuerst A. Gracilis muscle transposition for treatment of recurrent anovaginal, rectovaginal, rectourethral, and pouch-vaginal fistulas in patients with inflammatory bowel disease. Tech Coloproctol. 2019; 23: 43-52. Pubmed: https://www.ncbi.nlm.nih.gov/pubmed/30604248
  6. Hotouras A, Ribas Y, Zakeri S, Murphy J, Bhan C, et al. Gracilis muscle interposition for rectovaginal and anovaginal fistula repair: a systematic literature review. Colorectal Dis. 2015; 17: 104-110. Pubmed: https://www.ncbi.nlm.nih.gov/pubmed/25284745

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