Reviewer response for version 1
This article demonstrates that a HIFU induced RUF can be successsfully closed with a buccal graft and gracilis muscle flap. 
I agree with the authors that this technique is the preferred way to treat these RUF.
The article contends this is the first case demonstrating this in the literature. 
In fact, we published this first in 2010, in which 2 patients of our cohort had HIFU RUF that were successfully repaired with this technique. 
This report should be changed to appropriately acknowledge that we (Vanni et al ) were the first to demonstrate closure of HIFU RUF with this technique with the appropriate reference cited.
Here is this reference:
Vanni AJ 1 , Buckley JC , Zinman LN . Management of surgical and radiation induced rectourethral fistulas with an interposition muscle flap and selective buccal mucosal onlay graft. J Urol. 2010 Dec;184(6):2400-4.
- Another point: 
In the discussion the authors state:
"Zinman 9 described 68 patients with rectourethral fistula who underwent gracilis muscle flap repair out of which 27 were performed in combination with BMG".
This reference is antiquated and we have published 2 more extensive papers on the topic more recently that should be cited instead of the one used by the authors. 
Vanni et al is a better reference for this sentence and the one I previously mentioned above. 
In this paper, 74 patients had RUF repair with a gracilis muscle flap. 
39 of these patients had a RUF from an ablative source (radiation and 2 HIFU). 
Of these 39 patients, 34 had a buccal mucosa graft (including the 2 HIFU cases) used to close the urethral defect. 
37 of these patients had at least 1 gracilis muscle flap, while the other 2 patients had an inferior gluteus maximus flap and a Singapore fasciocutaneous flap.
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