AIM:To evaluate the efficacy of gracilis muscle transposition and postoperative salvage irrigation-suction in the treatment of complex rectovaginal fistulas(RVFs)and rectourethral fistulas(RUFs).METHODS:Between May 20...AIM:To evaluate the efficacy of gracilis muscle transposition and postoperative salvage irrigation-suction in the treatment of complex rectovaginal fistulas(RVFs)and rectourethral fistulas(RUFs).METHODS:Between May 2009 and March 2012,11female patients with complex RVFs and 8 male patients with RUFs were prospectively enrolled.Gracilis muscle transposition was undertaken in all patients and postoperative wound irrigation-suction was performed in patients with early leakage.Efficacy was assessed in terms of the success rate and surgical complications.SF-36 quality of life(QOL)scores and Wexner fecal incontinence scores were compared before and after surgery.RESULTS:The fistulas healed in 14 patients after gracilis muscle transposition;the initial healing rate was73.7%.Postoperative leakage occurred and continuous irrigation-suction of wounds was undertaken in 5patients:4 healed and 1 failed,and postoperative fecal diversions were performed for the patient whose treatment failed.At a median follow-up of 17 mo,the overall healing rate was 94.7%.Postoperative complications occurred in 4 cases.Significant improvement was observed in the quality outcomes framework scores(P<0.001)and Wexner fecal incontinence scores(P=0.002)after the successful healing of complex RVFs or RUFs.There was no significant difference in SF-36 QOL scores between the initial healing group and irrigationsuction-assisted healing group.CONCLUSION:Gracilis muscle transposition and postoperative salvage wound irrigation-suction gained a high success rate in the treatment of complex RVFs and RUFs.QOL and fecal incontinence were significantly improved after the successful healing of RVFs and RUFs.展开更多
Radiotherapy-induced urethral strictures(RIUS)decrease quality of life and present a great challenge for surgical reconstruction,especially due to proximal location,compromised vascular supply,and poor wound healing.I...Radiotherapy-induced urethral strictures(RIUS)decrease quality of life and present a great challenge for surgical reconstruction,especially due to proximal location,compromised vascular supply,and poor wound healing.It is unclear whether urethroplasty is an option in cases with stricture resulting from exposure to pelvic radiation.We review the pathophysiology,diagnostic workup,and disease-specific aspects of RIUS.Furthermore,we discuss several management alternatives such as excision and primary anastomosis,as well as techniques for open reconstruction with flaps.The most extensive techniques in the treatment of strictures include,for example,those using gracilis muscle flaps,as they can involve periurethral tissue to provide sufficient vascularity for excellent post-surgery urethral healing.In brief,RIUS represent a significant challenge.In carefully chosen patients,urethroplasty should be considered as a feasible and durable treatment.However,medical practitioners should always take into consideration that the results of urethroplasty in RIUS are not comparable to urethroplasties without a radiation background.展开更多
基金Supported by National Natural Science Foundation of China,No.81372586
文摘AIM:To evaluate the efficacy of gracilis muscle transposition and postoperative salvage irrigation-suction in the treatment of complex rectovaginal fistulas(RVFs)and rectourethral fistulas(RUFs).METHODS:Between May 2009 and March 2012,11female patients with complex RVFs and 8 male patients with RUFs were prospectively enrolled.Gracilis muscle transposition was undertaken in all patients and postoperative wound irrigation-suction was performed in patients with early leakage.Efficacy was assessed in terms of the success rate and surgical complications.SF-36 quality of life(QOL)scores and Wexner fecal incontinence scores were compared before and after surgery.RESULTS:The fistulas healed in 14 patients after gracilis muscle transposition;the initial healing rate was73.7%.Postoperative leakage occurred and continuous irrigation-suction of wounds was undertaken in 5patients:4 healed and 1 failed,and postoperative fecal diversions were performed for the patient whose treatment failed.At a median follow-up of 17 mo,the overall healing rate was 94.7%.Postoperative complications occurred in 4 cases.Significant improvement was observed in the quality outcomes framework scores(P<0.001)and Wexner fecal incontinence scores(P=0.002)after the successful healing of complex RVFs or RUFs.There was no significant difference in SF-36 QOL scores between the initial healing group and irrigationsuction-assisted healing group.CONCLUSION:Gracilis muscle transposition and postoperative salvage wound irrigation-suction gained a high success rate in the treatment of complex RVFs and RUFs.QOL and fecal incontinence were significantly improved after the successful healing of RVFs and RUFs.
文摘Radiotherapy-induced urethral strictures(RIUS)decrease quality of life and present a great challenge for surgical reconstruction,especially due to proximal location,compromised vascular supply,and poor wound healing.It is unclear whether urethroplasty is an option in cases with stricture resulting from exposure to pelvic radiation.We review the pathophysiology,diagnostic workup,and disease-specific aspects of RIUS.Furthermore,we discuss several management alternatives such as excision and primary anastomosis,as well as techniques for open reconstruction with flaps.The most extensive techniques in the treatment of strictures include,for example,those using gracilis muscle flaps,as they can involve periurethral tissue to provide sufficient vascularity for excellent post-surgery urethral healing.In brief,RIUS represent a significant challenge.In carefully chosen patients,urethroplasty should be considered as a feasible and durable treatment.However,medical practitioners should always take into consideration that the results of urethroplasty in RIUS are not comparable to urethroplasties without a radiation background.
