Chiloleti Geofrey, Mtaturu Gabriel, Mchele Godfrey, Ringo Yona, Mmbando Theoflo, Mwanga Ally
Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Department of Urology, Muhimbili National Hospital, Dar es salaam, Tanzania.
Int J Surg Case Rep. 2024 Oct;123:110280. doi: 10.1016/j.ijscr.2024.110280. Epub 2024 Sep 16.
An iatrogenic urethral perineal fistula can cause challenging problems for surgical reconstruction. In most cases, treatment is performed in three steps: double-diversion urinary and intestinal diversion, closure, and diversion. The augmented posterior urethroplasty interposition with a gracilis muscle function flap for the repair of the perineal gap was successful.
We reviewed a patient aged 42 years old male who presented to the urology department with leakage of urine per perineum after abdominal perineal resection and end colostomy due to anal-rectal malignancy 2 months earlier. He subsequently had a gapped perineal wound post abdominal-perineal resection (APR). Suprapubic Cystostomy and urethral catheter and a cystoscope showed a normal verumontanum, and there was a left para-verumontanum fistula approximately 3 cm in size that communicated with the perineum gapped wound. Tissue histology revealed chronic inflammation. Augmentation posterior urethroplasty with interposition of the gracilis muscle flap.
Urethral perineal fistulas have different etiologic origins, such as inflammatory, neoplastic, traumatic, or iatrogenic injury. Treatment is performed in three steps: double diversion urinary and intestinal, closure, and no diversion. In our case, the perineal gapped wound allowed us to access the posterior urethra and this potential space for gracilis muscle interposition, aiming to facilitate fistula repair and cover perineal gap wound repair.
Posterior urethral perineal fistulas can be repaired by a gracilis muscle flap, providing acceptable treatment results. However, more research is needed in fistula studies evaluating patients' sexual and urinary efficiency to achieve more accurate results.
医源性尿道会阴瘘会给手术重建带来棘手问题。多数情况下，治疗分三步进行：尿路和肠道双转流、闭合以及转流。采用股薄肌功能瓣进行增强型后尿道成形术并置入以修复会阴间隙获得成功。
我们回顾了一名42岁男性患者，他因两个月前的肛管直肠恶性肿瘤接受了腹会阴切除术及末端结肠造口术，之后出现会阴部尿液渗漏，遂就诊于泌尿外科。腹会阴切除术后，他出现了会阴间隙性伤口。耻骨上膀胱造瘘、尿道置管以及膀胱镜检查显示精阜正常，左侧精阜旁有一个约3厘米大小的瘘管，与会阴间隙性伤口相通。组织病理学显示为慢性炎症。采用股薄肌瓣进行增强型后尿道成形术。
尿道会阴瘘有不同的病因，如炎症性、肿瘤性、创伤性或医源性损伤。治疗分三步进行：尿路和肠道双转流、闭合以及不转流。在我们的病例中，会阴间隙性伤口使我们能够进入后尿道以及这个可用于置入股薄肌的潜在空间，目的是便于瘘管修复并覆盖会阴间隙伤口修复。
后尿道会阴瘘可通过股薄肌瓣修复，能提供可接受的治疗效果。然而，在评估患者性功能和排尿效率的瘘管研究方面，还需要更多研究以获得更准确的结果。
