Surgical management of rectourethral fistula after anoplasty

Abstract

Objective To summarize our experience of managing rectourethral fistula (RUF) after anoplasty. Methods From January 2008 to December 2014, a total of 46 patients with a mean age of 5.6 (1-16) years were reviewed retrospectively. Their outcomes were assessed after surgical repair. The etiologies were iatrogenic (n=2) and congenital (n=44). Despite normal anal function, all of them presented with a passage of urine through rectum or a defecation through urethra. They underwent retrograde urethrography and lower digestive tract imaging routinely. And fistula was diagnosed in 36 of them. Operative approach was determined by the distance between fistula and anal verge. The specific approaches were perineal (n=44), transanal (n=1) and posterior sagittal (n=1). Results Primary RUF closure was successful in 43 patients during a follow-up period of 6 months. Among three failed cases, one was cured after sitz bath with berberine for 1 month. Conclusions Perineal approach is associated with a low morbidity and a high success rate. It is ideal for most cases of fistula in a middle position. Transanal approach is indicated for lower ones. There is no need for bowel diversion before the above two procedures. For fistula in a high position, posterior sagittal approach may be adopted with bowel diversion. Key words: Abnormalities; Rectal fistula; Urinary fistula; Retrospective studies