Cystoscopic-assisted excision of rectourethral fistulas in males with anorectal malformations

Abstract

Introduction: We report a novel technique to label rectourethral fistulas in males with anorectal malformations who are undergoing posterior sagittal anorectoplasty (PSARP) to facilitate complete excision of the fistula.

Methods: Prior to performing PSARP in 21 male patients with rectourethral fistulas, cystoscopy was carried out to identify the orifice of the fistula within the urethra. A 3Fr ureteral catheter with calibrations was then inserted into the orifice to label the fistula. During the PSARP procedure, the rectourethral fistula was dissected to the junction of the urethra, as identified by the presence of the ureteral catheter, and the fistula tract was completely excised.

Results: Six prostatic and 15 bulbar rectourethral fistulas were found by cystoscopy. The orifices of the rectourethral fistulas were all located in the midline along the dorsal wall of the posterior urethra. The average length of the rectourethral fistulas was 10mm (range=5-15mm). During the PSARP procedure, the rectourethral fistula could be clearly identified, easily dissected and completely excised. Patients were followed up for 7-24 months. During the length of follow-up, micturition was normal and no urethral complications were found in any of the 21 patients.

Conclusion: Intraoperative cystoscopy with placement of a ureteral catheter in the fistula tract facilitates complete excision of rectourethral fistulas in males with anorectal malformations without risking injury to the urethra.

Keywords: Anorectal Malformation; Cystoscopy; Rectourethral Fistula.