H-type recto-urethral fistula presenting with recurrent epididymo-orchitis

Abstract

Anorectal malformation (ARM) is a congenital malformation that has an incidence of 1 in 5000. Krickenbeck classification separate different types of ARM according to the anatomy, with major clinical groups such as perineal fistula, rectourethral fistula (prostatic or bulbar), rectovesical, vestibular, cloaca, no fistula and anal stenosis. Recto-urethral fistula with a normal anus is a rare variant among all ARM with very few cases reported in previous literature. We hereby report a case with H type recto-urethral fistula with a rare clinical presentation of recurrent epididymo-orchitis, with our workup including micturating cystourethrogram (MCUG) and cystoscopy which revealed the fistula; subsequent surgical management using a modified anterior sagittal transrectal (ASTRA) approach and literature review on similar cases. Recto-urethral fistula with a normal anus is a rare condition and an ASTRA approach provides good early results. Furthermore, MCUG should be considered in boys with recurrent epididymitis to rule out urethral anomalies.