# A Case of Achieving Urinary Continence Using Gracilis Muscle Flap for Recanalization and Fistula After Bladder Neck Closure

## TL;DR

A patient regained urinary control after a gracilis muscle flap was used to fix a fistula following bladder neck closure surgery.

## Contribution

This case highlights the effectiveness of using a gracilis muscle flap to manage persistent fistulas after bladder neck closure.

## Key findings

- Bladder neck closure was recanalized early after surgery.
- A gracilis muscle flap successfully closed a persistent fistula and restored urinary continence.
- Transperineal urethral dissection combined with GMF coverage proved effective.

## Abstract

We present the case of a patient who achieved urinary continence after undergoing a gracilis muscle flap (GMF) for recanalization and fistula after bladder neck closure (BNC).

A male patient with neurogenic lower urinary tract dysfunction complained of difficulty inserting the catheter because of numerous false cavities in the prostatic urethra. We performed BNC to create a continent catheterizable stoma. However, the bladder neck was recanalized in the early postoperative period. Next, we dissected and closed the urethra transperineally. Due to the tiny fistula, the patient's urinary incontinence persisted. Finally, we dissected and closed the urethra again transperineally, and the closed area was covered with a GMF. Since then, the urethra has been completely closed, and urinary continence has been achieved.

The possibility of recanalization after BNC must be kept in mind. Interposition and covering of the GMF are useful techniques for urethral and perineal fistulas.