Autologous Rectus Fascia Graft Interposition Repair of Urethrocutaneous Fistulae in Female-to-Male Metoidioplasty Patients.

OBJECTIVE

To describe our technique and outcomes using an autologous rectus fascia interposition graft for repair of recurrent urethrocutaneous fistulae (UCF) following metoidioplasty.

MATERIALS AND

METHODS

A circumferential incision is made to the skin surrounding the UCF and carried to the level of the underlying subcutaneous tissues. The inner fistula skin edges are closed with a running 5-0 monofilament absorbable suture to obliterate the urethral side. The length of the urethral wound is measured and an appropriate sized rectus fascia graft harvested from a small transverse lower abdominal incision that is also used for concomitant percutaneous suprapubic tube placement. Prior to outer skin closure with a running 5-0 monofilament absorbable suture, the fascial graft is spread-fixed between the urethra and skin to avoid overlapping suture lines. A 10-French urethral catheter is removed after 10 days and the suprapubic catheter removed after 2-3 weeks.

RESULTS

Three patients have undergone repair of recurrent UCF with this technique since February 2017. All patients had undergone metoidioplasty with a mean time to fistula occurrence of 3.2 months. Mean number of prior UCF repairs was 3.0. With a median follow-up since repair of 7.0 months (range 4-8), no patient has reported UCF recurrence.

CONCLUSION

UCF following metoidioplasty is a difficult surgical complication. Fistula closure with interposition of autologous rectus fascia allows for separation of suture lines and encourages healing without extensive reconstruction.