Vascularisation of Urethral Repairs with the Gracilis Muscle Flap
A 64-year-old man presented with a stage IIc rectal carcinoma. He underwent an abdominoperineal resection which included part of the posterior wall of the prostatic urethra as the tumour was adherent to it. The defect was repaired and despite suprapubic urinary diversion, a urethrocutaneous fistula developed 1 month later. Repeat surgery showed a small prostate remnant with a 3 cm prostatic urethral defect. The prostate remnant with its urethral segment were resected to the bladder neck (). The bulbar urethra was then mobilised and anastomosed directly to the bladder neck. There was an absence of soft tissue posterior to the anastomosis due to the previous abdominoperineal resection. A gracilis muscle was wrapped around the anastomosis to buttress and support it (). In addition, a gluteus maximus muscle flap was transposed into the pelvic cavity to obliterate the dead space. He had an uncomplicated recovery and the MCU showed smooth passage of urine with no stricture or leak after 3 months (). However, he was incontinent and had to wear diapers.