Urethral fistulas can be a result of trauma or infection and
can be a challenge to close for both the physician and patient. Closure of the
wound requires urinary diversion and well vascularized tissue to close the
wound. Of paramount importance when repairing urethral fistulas, is that there
should be no downstream obstruction, so that a decreased resistance allows
closure.
When there is a stricture of the urethra, a free buccal
mucosal graft from the mouth can be used to substitute for the urinary
epithelium. Buttressing of the buccal mucosal graft requires well vascularized
tissue. The gracilis muscle is an excellent choice, for bringing in well vascularized
tissue into the perineum. Hyperbaric oxygen can be a useful adjunct to faciliate wound closure.
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