Three-layer reconstruction of large urethrocutaneous fistulas using scrotal-septal flaps

Abstract

Cite as: Can Urol Assoc J 2014;8(11-12):e828-31. http://dx.doi.org/10.5489/cuaj.1983 Published online November 24, 2014. AbstractIntroduction: The repair of large urethrocutaneous fistulas (UCFs) commonly involves reconstruction of the urethra, waterproof layer and skin coverage, which deploy different tissues from different flaps. To simplify the multiple procedures, we explored to use one flap (a scrotal-septal flap) to reconstruct three layers in UCF repairing in one stage. Methods: Between January 2011 and July 2012, 29 patients with large UCFs (ranging from 1.0 to 2.0 cm) were treated using scrotal-septal flaps for three-layer reconstruction. Every patient has an unbroken scrotum. The hair follicles in the donor site were destroyed using a radiosurgical knife 2 months before the operation. The flap was divided into three zones, which were flipped, folded, and extended respectively to form the urethra, waterproof layer and skin coverage. Results: The patients were followed up between 6 to 12 months. No fistula recurrence was observed. All flaps survived, except in one case, in which the distal skin flap was lost but stenosis or fistula did not develop. Two patients underwent second operations to refine the aesthetic results. Conclusions: The scrotal-septal flap can be transferred in an overturning-folding-advancement fashion and can simultaneously involve the reconstruction of the urethra, waterproof barrier and skin coverage. This is a simple and reliable alternative for large UCFs (≤2 cm) repairing at the penoscrotal junction; however, it cannot be used in patients with a damaged scrotal septum.

Side-to-side penoscrotal anastomosis: a reliable technique for repair of recurrent urethrocutaneous fistula in male children

“…In another report, a scrotal septal flap was used to repair a wide UCF. 17 This technique seems quite good but technically difficult for UCFs in the distal part of the urethra. The situation of increased scarring and poor peri-fistula blood supply and high potential of re-fistulation was what inspired us to consider this novel technique.…”

Urethroplasty wıth the Use of a Turnover Flap for Correctıon of Problematıc Urethrocutaneous Fıstula: Report of a Case and Revıew of the Lıterature

“…However, another group of plastic surgeons preferred to use scrotal septal flaps. 11 Firstly, they destroyed the hair follicles in the donor site 2 months before the operation. Eventually, they covered the urethral defect with a longitudinal flap isolated from the scrotal septum.…”

Fistulas of the lower urinary tract in children

“…Il punto cardine della chirurgia di questo tipo di fistole è la resezione generosa nella sede dello sbocco uretrale che permette una sutura dei margini su tessuto sano e soprattutto la copertura con strati multipli di tessuti circostanti: dartos, tonaca vaginale, flap prepuziale o scrotale (15). In caso di fistole plurirecidive è preferibile un reintervento di uretroplastica.…”