Youssef A H, Fath-Alla M, El-Kassaby A W
Department of Urology, Ain-Shams University, Cairo, Egypt.
J Urol. 1999 May;161(5):1498-500.
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.
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.
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.
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.
尿道直肠瘘较为罕见，其病因通常为创伤性或医源性（术后）。已有多种手术方法和技术用于瘘管修复，但尚无一种方法被证明是最佳的或普遍可接受的。我们介绍一种修复尿道直肠瘘的新技术。
1990年至1997年，我们采用会阴皮下肉膜带蒂皮瓣手术成功治疗了12例年龄在7至65岁之间的男性尿道直肠瘘患者。尿道直肠瘘由骨盆挤压伤导致的有6例，枪伤导致的有2例，前列腺切除术后发生的有4例。4例瘘管合并尿道狭窄。所有尿道直肠瘘病例均采用会阴入路，4例合并后尿道狭窄的患者联合经耻骨联合入路。我们在修复的直肠和尿道之间置入皮下肉膜带蒂皮瓣作为带血管蒂组织瓣。
我们的技术在所有病例中效果均极佳。未出现渗漏或会阴部积液，也无瘘管复发。1例患者的尿道狭窄通过直视下尿道内切开术处理。4例患者因内外括约肌损伤导致尿失禁，其中包括枪伤（2例）、骨盆挤压伤（1例）和前列腺切除术（1例）。随访时间为9至42个月。
我们的会阴皮下肉膜带蒂皮瓣技术符合成功修复尿道直肠瘘的所有原则。我们认为它是解决这一泌尿外科难题的理想方法。
