PMC5310386_01
Cystouethroscopy showing urethral defect.
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Repeat cystoscopy after 3 months showed persistent fistula ( Figure 1).
Perineal incision above anus.
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An inverted smiling incision was made in the perineum above the anus ( Figure 2).
Rectal wall defect at the level of fistula.
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The fistula was at the 1 o' clock position between the prostatic urethra and rectum ( Figure 3).
Suture line of rectal wall defect repair.
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The rectal defect was repaired in transverse fashion in a single layer with monocryl 2-0 sutures ( Figure 4).
Buccal mucosal graft (BMG) with anchoring sutures.
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BMG was harvested and positioned to bridge the urethral defect; it was anchored with interrupted 3-0 monofilament sutures ( Figure 5).
Gracilis muscle flap rotated to perineum.
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The gracilis muscle flap was harvested, rotated towards the perineum ( Figure 6) and interposed between the rectal and urethal repair ( Figure 7).
Gracilis muscle flap interposed and fixed between rectal and urethal repair.
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The gracilis muscle flap was harvested, rotated towards the perineum ( Figure 6) and interposed between the rectal and urethal repair ( Figure 7).