Optimizing Flap Selection for Urosymphyseal Fistula Repair: A Comparative Analysis of Surgical Outcomes.

Abstract

There is limited data regarding the surgical outcomes of urosymphyseal fistula (USF) repair with primary repair or autologous tissue transfer. We performed a study to compare outcomes of USF repair with primary repair, VRAM flap, and omental flap. We retrospectively identified patients with a diagnosis of USF who underwent fistula decompression and urinary tract reconstruction. The minimal follow-up was 3 months. Patients with distal urethral obstruction, radiation cystitis, or a non-viable sphincter underwent anterior exenteration and flap transfer. Fifty-six patients were included. Eleven patients underwent surgical management for USF using primary repair (19.6%), 34 had omental flap-based reconstruction (60.8%), and a VRAM flap was used in 11 patients (19.6%). The 90-day rate of sepsis was lower with omentum flap transposition (3%) compared with VRAM flap (27%) or primary repair (18%, p = 0.041). The rate of fistula recurrence was lower in the omentum flap group compared with USF primary repair (30%) or VRAM flap repair group (27.3%, p = 0.04). On multivariable analysis, USF repair with the omentum flap decreased the odds of fistula recurrence 90 days after surgery compared with primary repair (OR 0.012, p = 0.011) but not when compared with VRAM. The omentum flap may offer a better safety profile in terms of decreasing the rate of early sepsis and rate of fistula recurrence for USF repair in comparison to primary repair. There is limited evidence regarding the superiority of the omentum flap to decrease the rate of late fistula recurrence when compared with the VRAM flap.