Correlation between congenital pelvic floor muscle development assessed by magnetic resonance imaging and postoperative defecation.

OBJECTIVE: Children with congenital anorectal malformation (CAM) experience challenges with defecation. This study aims to assess defecation in preschool-age children with CAM and to evaluate the correlation between pelvic floor muscle developed assessed by magnetic resonance imaging (MRI) and postoperative defecation. METHODS: We collected clinical data and MRI results from 89 male children with CAM. The bowel function scores for children with Perineal (cutaneous) fistula, Rectourethral fistula(Prostatic or Bulbar), and Rectovesical fistula were computed. MRI scans were subjected to image analysis of the striated muscle complex (SMC). The association between pelvic floor muscle score and bowel function score was examined using the Cochran-Armitage Trend Test. RESULTS: We observed that 77.4% of the SMC scores by MRI for Perineal fistula were good. The Rectourethral fistula SMC score was 40.6% for moderate and 59.4% for poor. The SMC score for Rectovesical fistula was 100% for moderate. Furthermore, 77.4% of patients with Perineal fistula had bowel function scores (BFS) ≥ 17 points. Among those with Rectourethral fistula and Rectovesical fistula, 12.5% and 0 had BFS ≥ 17 points, respectively. An analysis of muscle development and bowel function in patients with Rectovesical fistula, Rectourethral fistula, and Perineal fistula revealed a correlation between SMC development and BFS. Subgroup analysis showed that the Perineal fistula had statistical significance; however, the Rectourethral fistula and Rectovesical fistula were not statistically significant. CONCLUSION: A correlation exists between pelvic floor muscle development and postoperative defecation in children with Perineal fistula.

Mid-Perineal Scrotal Flap for the Repair of Urorectal Fistulas: A New Technique.

Rectourethral fistula (RUF) is an infrequent but severe complication of the treatment of prostate cancer. Herein, we describe a new surgical approach used successfully in 3 patients that incorporates a partially de-epithelialized mid-perineal scrotal flap (MPSF), used as interposition flap, that can be used in almost every patient with RUF after radiotherapy, regardless of having or not a concomitant posterior urethra or bladder neck stricture or contracture that might require a simultaneous urethroplasty. The interposition flap includes well vascularized subcutaneous fat tissue by distal vascular branches of the internal pudendal vessels that reaches without tension the deep perineum up to the posterior bladder neck. The MPSF is a time efficient procedure that allows excellent access to the bulbar urethra and to the surgical plane between rectum and prostate and it does not require a separate incision for the flap harvesting procedure when required.

[Diagnosis and treatment of rectal injury during laparoscopic radical prostatectomy: Analysis of 7 cases].

OBJECTIVE: To explore the risk factors and management principles of rectal injury during laparoscopic radical prostatectomy (LRP). METHODS: We retrospectively analyzed the clinical data on 7 cases of LRP complicated with rectal injury and treated in Huzhou Central Hospital from January 2010 to June 2021. Four of the 7 PCa patients were found with complete rectal rupture during LRP, of whom 2 were treated by laparoscopic rectal repair (LRR) and the other 2 by LRR + colostomy during surgery. Another case of rectal muscle injury also underwent LRR. Two cases of delayed rectal rupture were observed postoperatively and treated by colostomy + transrectal repair in the second-stage operation. RESULTS: The rectal injuries were found in the apex of the prostate in all the 7 cases, pathologically staged as pT2b��pT3b and with Gleason scores of 7��10. Postoperative follow-up lasted 2 to 18 months, during which the 5 cases of intraoperative rectal repair recovered well without complications, and of the 2 cases of postoperative rectal repair, 1 made a good recovery and the other 1 developed rectourethral fistula. CONCLUSION: Rectal injury during radical prostatectomy tends to occur in the apex of the prostate and can be effectively managed by laparoscopic repair. Meanwhile, attention should be paid to the postoperative complication of rectourethral fistula.

A novel combined enteroscopy and laparoscopy approach to prevent urethral complications in management of rectourethral fistula.

BACKGROUND: For the last 20 years, laparoscopy management of anorectal malformations (ARM) has been challenged due to the development of postoperative urethral diverticulum or injury caused by the imprecise transection of rectourethral fistulae, particularly rectobulbar fistulae situated deep in the pelvis. We have developed a combined approach of enteroscopy and laparoscopy for intraluminal incision of a rectourethral fistula. METHODS: We retrospectively reviewed 47 ARM patients who underwent surgical corrections using the combined approach between January 2019 and June 2020. Early postoperative and subsequent follow-up results were evaluated. RESULTS: The median follow-up period was 12 months. The average age at surgery was 3.18 ± 0.64 months. The mean operative time of a single-incision laparoscopic-assisted anorectoplasty (SILAARP) was 1.19 ± 0.29 h. The time for intraluminal incision of the fistula was shortened from 14 to 2 min. No patients underwent a conversion. The average postoperative hospital stay, time to full feeds and placement of an anal tube were 10 days, 1 day, and 5 days, respectively. No urethral diverticulum, urinary injury, wound infection, rectal retraction, anal stenosis or rectal prolapse was encountered in the cohort. CONCLUSIONS: The combined enteroscopy and laparoscopy approach offers precise management of rectourethral fistulae. It could effectively obviate urethral complications, eliminating the obstacles of laparoscopy application in the management of ARMs.

Transanal fistulectomy for postoperative persistent rectourethral fistula in patients with ARM: is simple resection enough?

BACKGROUND: Postoperative rectourethral fistula (RUF) in patients with congenital anorectal malformation (ARM) remains a challenge for paediatric surgeons, among them persistent fistula is the most common. Various techniques have been proposed, only a few reports based on different causes are available, and there is no consensus so far. This study is to evaluate the application, advantages and limitations of transanal fistulectomy approach in repairing persistent RUF in ARM patients. METHODS: From January 2007 to July 2019, 78 ARM patients who received revisional surgery for RUF were reviewed, 34 persistent fistulas were identified. Examination under anaesthesia included patients with fistulas that were located within 3 cm from the anus verge, good appearance of the anus and sphincter function, and no urethral and rectoanal obstruction. Three patients were excluded because of complex urologic pathologic defects. In total, thirty-one patients underwent transanal fistulectomy to repair RUF. RESULTS: All cases were approached with transanal incision and fistulectomy to repair RUF. The average operative time was 91 ± 35 min. At a minimum six-month follow-up, 29 patients healed after the first attempt, the success closure rate was 93.5%. Two patients received redo transanal fistulectomy and healed. Two patients had postoperative complications: one patient had urethral stenosis and it was managed by dilation; one patient had urethral diverticulum but it did not require revisional surgery. No patient in this study was incontinent because of the surgery. CONCLUSIONS: Transanal fistulectomy provides a simple, straightforward, and safe approach to repair persistent RUF in ARM patients, especially in those with a low-lying fistula, good anus appearance and sphincter function without obstruction in the rectum or urethra. TRIAL REGISTRATION: Retrospectively registered.

Advance in research of treatment and prognosis of iatrogenic rectourethral fistula. / åŒ»æºæ€§å°¿é“ç›´è‚ ç˜˜æ²»ç–—å’Œé¢„åŽçš„ç ”ç©¶è¿›å±•.

Recturethral fistula (RUF) is a kind of serious complication that mainly happened during the treatment of prostate cancer. It has become one of the most difficult diseases to treat in urology because of its special anatomical location, complicated condition, and the varied prognosis. At present, the main treatment methods for RUF are conservative treatment such as application of antibiotics and indwelling catheters, etc. and surgical treatment such as transperineal approach, transsphincter approach, transanal approach, transabdominal approach, etc. However, there is no explicit treatment protocol for RUF. What's more, the etiology of RUF has changed greatly in recent years. Summarizing the advantages and disadvantages of different RUF's treatment methods and their prognosis will be helpful for the decision of clinical treatment.

Surgical management of acquired rectourethral fistula: a retrospective analysis of 52 consecutive patients.

BACKGROUND: Acquired rectourethral fistula (RUF) is an uncommon complication mostly resulting from surgery or radiation. Standardization of the surgical management is lacking. The aim of this study was to report our experience with surgery for RUF. METHODS: This was a retrospective study of a prospectively maintained clinical database. The surgical strategy was tailored to complexity of RUF, presence of sepsis, history of radiation and residual urinary/fecal functionality. Outcomes measured were RUF closure and permanent fecal/urinary diversion. Impact of radiotherapy was also assessed. RESULTS: Between November 2002 and January 2019, 52 patients were identified (100% males). Median follow-up was 10.5 (0.5-16.8) years. Three patients had RUF closure after conservative management. The remaining 49 patients had a total of 76 procedures. The cumulative closure rate after the first, second and third attempt was 55.1%, 85.7% and 95.9%, respectively. Fistula closure together with preservation of the fecal and urinary function was achieved in 49%, 65.3% and 67.3% after the first, second and third repair, respectively. The overall success rate for transanal, transperineal, restorative transabdominal and non-restorative transabdominal procedures was 35.7%, 64.3%, 57.1% and 94.1%, respectively. A significantly higher rate of urinary/intestinal stomas was observed in the irradiated vs non-irradiated patients (84.2% vs 42.4%; p = 0.004). CONCLUSIONS: Surgery ensured healing in 96% of the patients. Radiotherapy led to higher rate of permanent urinary/fecal diversion. Nearly all irradiated patients who had transabdominal repair end up with a definitive stoma. When transperineal repair with gracilis flap interposition was used, the rate of fistula closure approached 90%. A treatment algorithm is proposed.

Rectal advancement flap plus adipose lipofilling (RAFAL) for the treatment of rectourethral fistulas after radical prostatectomy.

BACKGROUND: Rectourethral fistula (RUF) is a rare but significant complication after radical prostatectomy. Many different approaches have been used, but none of them has become the standard of care. METHODS: We present our series of seven patients treated with a transanal rectal advancement flap plus the injection of mesenchymal stem cells, to facilitate the healing of the fistula. Mesenchymal cells were obtained by a new mechanical device known as LIPOGEMS®. We called this technique RAFAL (rectal advancement flap plus adipose lipofilling). In all patients the RUF was a complication of laparoscopic radical prostatectomy. Fistula size ranged from 0.3 to 0.5 cm (median 0.4 cm). RESULTS: After a median follow-up of 53 months (range 6-163 months), 2 out of 7 patients experienced RUF recurrence. In both cases recurrence was successfully treated by the York-Mason technique in one case and by redo RAFAL in the other. Success rate of RAFAL was 71% (5 of 7). The total success rate of primary RAFAL and redo- RAFAL was 85.7% (6 of 7). No short- or long-term complications were seen. CONCLUSIONS: In our patient population this new procedure was safe and effective.

[Conservative management of rectourethral fistula: modern treatment].

INTRODUCTION: & Objectives. Rectal injury and recto-urethral fistula (RUF) formation are severe complications after surgical treatment of prostate cancer . There are various surgical techniques as well as conservative methods for the treatment of RUF. Nonsurgical approach can be used in nontoxic, minimally symptomatic patients. MATERIALS & METHODS: From 2012 to 2016, 825 patients (mean age 68y) with LPR to be performed were recruited in the study. Postoperatively RUF developed in 7 patients (0.8%) in average in 10 days after surgery. Five cases were uncomplicated presented with pneumaturia, dysuria or urine per rectum. Two patients with fecaluria and previous history of radiotherapy or androgen deprivation were excluded from the study group. Conservative management include: 1)bowel rest 2)broad-spectrum antibiotics after urine culture 3) fully absorbable diet (combination of parenteral and enteral nutrition) 4) bladder drainage (urethral catheter or suprapubic tube). Duration of conservative treatment was 4 weeks. After treatment all patients underwent a voiding cystourethrogram. RESULTS: During the treatment one patient has developed severe UTIs and surgical treatment were perfomed. The remaining 4 patients had spontaneous healing of the fistula and normal cystourethrogram. With the median follow up of 24 month after RUF treatment all 4patients had no fistula signs and they were fully continent. Overall RUF closure using nonsurgical treatment was successful in 4 of 5 cases (80%). CONCLUSIONS: Conservative management of RUF is a highly effective option which can be used to avoid major surgery and temporary colostomy. Nonsurgical treatment is a feasible method in selected patients with RUF.

Transsphincteric repair of rectourethral fistulas: 15 years of experience with the York Mason approach.

OBJECTIVES: To evaluate the surgical and functional outcomes of our single institution's 15-year experience with surgically treated rectourethral fistulas using a modification of the York Mason technique. METHODS: Prospectively recorded data between 2002 and 2016 of all patients who underwent transsphincteric repair of rectourethral fistula using a modified York Mason technique at Eskilstuna County Hospital, Eskilstuna, Sweden, were assessed. A total of 20 consecutive patients, including 17 referrals (85%) and three patients (15%) from our hospital have undergone the modified York Mason procedure. The surgical and functional outcomes were evaluated. RESULTS: Of the 20 patients, 18 were repaired successfully (90%), and one was combined with a dartos muscle interposition flap. No fistula recurrence occurred in the 18 successful repairs during the median follow-up time of 84.7 months. Before fistula repair, 12 patients (60%) underwent a diverting stoma. The remaining eight patients (40%) underwent repair and synchronous diverting stoma. We did not find any significant differences between patients in which the repair was successful compared with patients with failed repair, but diabetes, smoking and preoperative irradiation were much more frequent in the failed group. Of the 18 patients who had a successful repair, 17 patients experienced normal voiding and no urinary incontinence. One patient was suffering from postprostatectomy incontinence before rectourethral fistula repair, and was successfully treated with Scott prosthesis. All the 13 patients in whom the stoma had been closed reported intact fecal continence and no anal stenosis postoperatively. CONCLUSIONS: The transsphincteric modified York Mason approach offers excellent exposure and a high fistula closure rate without fecal and urinary incontinence.

Laparoscopic dissection and division of distal fistula in boys with rectourethral fistula.

BACKGROUND: Congenital rectourethral fistula (RUF) is the most common form of anorectal malformations found in boys. The aim of this study is to review our experience with dissection and division of distal fistula using laparoscopic surgery in the management of RUF, especially rectourethral bulbar fistula. METHODS: One hundred and two consecutive boys with congenital RUF who underwent conventional or single-incision laparoscopic surgery between July 2008 and June 2015 were enrolled in the study. The dissection of the distal fistula was performed along submucosal layer to a level 0.5 cm proximal to the urethra. Rectal mucosa of the fistula was dissected to the distal most point and completely transected flush with the posterior urethra. The residual muscular cuff was ligated with Hem-o-Lock clip or 5-0 PDS suture. Voiding cystourethrography and pelvic magnetic resonance imaging were performed at 3 mo, 6 mo, and 1 y postoperatively. RESULTS: All patients successfully underwent laparoscopic surgery without conversion. The mean age at the time of operation was 4.3 ± 2.9 mo. The operative times for the rectoprostatic fistula and rectobulbar fistula were similar (118.2 versus 119.4 min, P = 0.082). There was no significant difference in average operative time between conventional laparoscopic surgery group and single-incision laparoscopic surgery group (118.8 versus 119.1 min, P = 0.281). There was no injury to the urethra or vas deferens. The urethral catheter was removed on postoperative day 10. All patients were followed up. The median follow-up period was 3.3 ± 1.8 y. No recurrent fistula or urethral diverticulum was detected on voiding cystourethrography and pelvic MRI at 1 y. CONCLUSIONS: Submucosal dissection and division of distal fistula using a laparoscopic approach is safe, feasible, and effective for congenital RUF, especially bulbar fistula, in boys.

Laparoscopic-assisted Anorectoplasty: A Single-center Experience.

AIM: To assess the modifications in the technique of laparoscopic-assisted anorectal pull-through (LAARP) practiced at our institute and to analyze the postoperative outcome and associated complications. MATERIALS AND METHODS: A retrospective study was done to analyze the results for LAARP procedure done for high anorectal malformations (ARMs) from January 2001 to May 2016. A total of 68 patients had undergone LAARP, with 62 male and 6 female children. Staged procedure was done in 55 patients and one child with rectovestibular fistula of 5 months of age had a single-stage procedure. Technical modifications such as traction over the fistula which helps in identification and dissection of the puborectalis muscle, dividing the fistula without ligation, railroading with Hegar's dilators over the suction cannula which creates adequate pull-through channel, have helped save time and make the procedure simpler. The patients were followed up with clinical evaluation and continence scoring. RESULTS: All the patients withstood surgery well. One patient with rectovesical fistula required conversion to gain adequate length of the distal rectum, for whom the colostomy was closed and relocated at splenic flexure level. The complications were mucosal prolapse (8 cases), anal stenosis (5), adhesive obstruction (2), distal rectal necrosis (3), and urethral diverticulum (2). The progress has been satisfactory and weight gain is adequate. 71.15% patients had good continence on follow-up. CONCLUSION: LAARP procedure is safe for high ARMs with good continence and correctable side effects. It has completely replaced posterior sagittal anorectoplasty procedure for high anomalies in our practice.

Rectourethral Fistula Management.

Rectourethral fistula (RUF) is a rare condition that occurs, in most cases, as a consequence of prostate cancer treatments. Clinical suspicion and proper assessment prior to surgery are essential to adapt and successfully carry out an appropriate treatment plan. There are no randomized trials to guide clinical practice, and therefore, scientific evidence in this respect is limited. Expert recommendations seem to agree on the transperineal approach with flap interposition as the surgical treatment of choice in cases of complex fistulas, especially in those that have undergone prior radiation. Undoubtedly, the key to the successful treatment of the disease is the multidisciplinary and standardized management by physicians with experience in the field.

Intersphincteric approach for rectourethral fistulas following radical prostatectomy.

BACKGROUND: Rectourethral fistula is a challenging complication of radical retropubic prostatectomy. Several treatments have been proposed, with varying outcomes. The available data are difficult to interpret, because patient and disease characteristics differ significantly among reports. Details of long-term follow-up and functional status are rarely provided. We describe a technique of rectourethral fistula repair via an intersphincteric route. METHODS: Preoperative workup included proctoscopy and urethrocystography. All patients already had a stoma at the time of fistula repair. Mechanical cleansing of the bowel distal to the colostomy was routinely performed, and perioperative antibiotic prophylaxis was administered. Patients were placed in the lithotomy position. Under spinal anesthesia, a curvilinear anteanal incision was made, to expose the external sphincter. The anterior portion of the external sphincter was gently displaced along half of its circumference. The anterior rectal wall was sharply dissected free from the urethra, approximately up to 2 cm above the fistula level through the intersphincteric plane. The fistula was identified. The surrounding tissues were mobilized to obtain a tension-free repair of the urethral defect, using a single row of 4-0 polyglactin transverse, interrupted sutures. Transanally, a U-shaped full-thickness rectal flap was advanced and sutured with 3-0 monofilament interrupted sutures to cover the rectal opening, and care was taken to ensure that the two suture lines were in different planes. The catheter was left in place for 4 weeks. Patients were evaluated at 3-month follow-up for stoma closure. RESULTS: We successfully treated five patients. Only one minor complication was observed (surgical site infection). Stomas were taken down uneventfully. After a median follow-up duration of 2 years (range 2-3 years), no patients had fistula recurrence or impaired continence. CONCLUSIONS: Intersphincteric repair should be considered as an effective option in patients with iatrogenic rectourethral fistulas. This technique offers several advantages over alternative procedures that require more extensive approaches or invasive manipulation of the anal sphincters.

[Augmented-pressure colostogram in the radiological assessment of anorectal malformations]. / El colostograma distal a presión en el manejo radiológico de las malformaciones anorrectales.

OBJECTIVES: To present our experience in detecting the existence of a possible associated fistula between the pouch colon and the urogenital tract in patients with anorectal malformations by carrying out an augmented-pressure colostogram, and its subsequent correlation between radiological and surgical findings. MATERIAL AND METHODS: A 17-year retrospective revision of 43 patients with anorectal malformations was performed. 34 of them were referred to the Radiology Department in order to carry out an augmented-pressure distal colostogram prior to surgery. RESULTS: A fistula was demonstrated in 26 of the 34 patients who had an augmented-pressure distal colostogram done. In the remaining 8 patients, this technique failed to demonstrate a fistula. The radiological findings were confirmed during the surgery in each case. CONCLUSIONS: The augmented-pressure distal colostogram is a simple and accurate study to delineate the altered anatomy of anorectal malformations, to define the distance between pouch colon and perineum, and to identify the localization of any associated fistulous communication. It is the most dependable test for a surgeon in order to choose the type of surgical approach, which depends on the presence or absence of an associated fistula.

OBJETIVOS: Presentar nuestra experiencia en la detección de las fístulas asociadas a las malformaciones anorrectales (MAR), utilizando como método diagnóstico el colostograma distal a presión y su posterior correlación entre los hallazgos radiológicos y quirúrgicos. MATERIAL Y METODOS: Se han revisado retrospectivamente, en un periodo de 17 años, 43 pacientes con diagnóstico de malformación anorrectal, de los cuales 34 fueron remitidos al Servicio de Radiología para la realización de un colostograma distal a presión antes de la cirugía. RESULTADOS: De los 34 casos en los que se realizó el colostograma distal a presión, en 26 se objetivó la existencia de una fístula y en los 8 casos restantes no. En todos los casos nuestros hallazgos radiológicos fueron confirmados posteriormente en la intervención quirúrgica. CONCLUSIONES: El colostograma distal a presión es una prueba diagnóstica sencilla y precisa para definir la anatomía alterada de las MAR, conocer la distancia entre el bolsón rectal y el margen anal, y la localización anatómica de las fístulas asociadas. Es la exploración diagnóstica más fiable para la elección de la vía de abordaje quirúrgica por parte del cirujano, condicionada por la existencia o no de una fístula.

Perineal Disintegration Syndrome (PDS) in Children With Human Immunodeficiency Virus (HIV) Infection: A Scoping Review.

BACKGROUND: Paediatric healthcare for children with HIV involves managing complex challenges, including severe perineal issues that significantly affect their quality of life. We introduce the term "perineal disintegration syndrome" (PDS) to describe conditions characterised by abscesses and various fistulae involving the anus, rectum, urethra, or reproductive tracts. The literature on PDS is limited and lacks a standardised treatment approach and universally accepted terminology. Our proposal for a new term aims to standardise nomenclature and stimulate targeted research to improve management and outcomes for this vulnerable group. OBJECTIVES: The aim of the study was to conduct a comprehensive analysis of the existing literature on PDS in paediatric HIV patients to uncover key findings, identify knowledge gaps, and outline practical implications and recommendations for clinical care and future research. METHODS: A systematic search across databases with comprehensive keywords identified relevant articles on PDS in paediatric HIV patients was conducted. RESULTS: The review emphasises the focus of PDS literature in African nations, highlighting the urgent need for research and clinical attention in HIV/AIDS-burdened regions. Challenges in diagnosing and managing PDS, uncertainties in its causes, and the lack of standardised management approaches in resource-constrained settings were revealed. CONCLUSION: This review emphasises the importance of prospective research, standardised protocols and patient-centred multidisciplinary care in managing PDS in paediatric HIV patients to improve care and outcomes of this population. LEVEL OF EVIDENCE: I.

Effect of prior radiotherapy and ablative therapy on surgical outcomes for the treatment of rectourethral fistulas.

PURPOSE: We evaluate the impact of pelvic radiation and ablative therapy on the surgical repair of rectourethral fistula. MATERIALS AND METHODS: A total of 45 patients with rectourethral fistulas were identified from a prospective database. From 1998 to 2010 a total of 49 surgical reconstructive procedures were performed. Fistula formation was secondary to radiation (brachytherapy, external beam radiation) and ablative therapy (cryotherapy or high intensity focused ultrasound) in 29 patients. The approach for surgical repair and clinical outcomes were analyzed to identify the impact of radiation and ablative therapy on successful fistula repair. RESULTS: Median patient age was 68 years and mean followup was 42 months (IQR 7, 71). A primary repair was more frequently attempted (15 of 16 [94%] vs 6 of 29 [21%], p <0.0001) and successful in nonradiation/ablation cases (13 of 15 [87%] vs 1 of 6 [17%], p = 0.003). Patients with prior radiation/ablation were significantly more likely to require permanent colostomy (25 of 29 [86%] vs 0%, p <0.0001) and permanent urinary diversion as part of fistula management (27 of 29 [93%] vs 1 of 16 [6%], p <0.0001). Of the 6 patients with radiation/ablation induced fistula who underwent primary repair, 4 subsequently required urinary diversion for fistula recurrence, 1 is symptomatic with recurrence and 1 (who presented with a 0.5 cm fistula) has had no evidence of fistula recurrence. CONCLUSIONS: Unlike the repair of a rectourethral fistula after surgical intervention, which is typically amenable to primary repair, most patients with severe radiation and ablation induced fistula will require urinary diversion with or without permanent colostomy. Thus, permanent urinary diversion should be considered early in the surgical management of these cases.

Nonclosure of rectourethral fistula during posterior sagittal anorectoplasty: Our experience.

AIM: To study the effect of nonclosure of rectourethral (RU) fistula and to do a comparative analysis of the complications with and without nonclosure of RU fistula during posterior sagittal anorectoplasty (PSARP) in anorectal malformation cases (ARM). MATERIALS AND METHODS: A total of 68 cases of ARM were included in the study group, of which 34 cases were those in whom RU fistula was not closed (group A) during PSARP. Another 34 successive cases were included in study group B in whom the RU fistula was closed as is conventionally done by using interrupted sutures. RESULTS: Comparatively, group A had none or minimum urological complications as compared to Group B. CONCLUSION: RU fistula closure is not mandatory during PSARP and nonclosure avoids urological complications. It especially avoids urethral complications, which are 100% preventable.

Traumatic rectourethral fistula repair: A potential application of porcine small intestinal submucosa.

Rectourethral fistula is an uncommon but devastating condition. Traumatic rectourethral fistula is still uncommon and repair of traumatic rectourethral fistula involves a complex procedure. Most of the urologists would prefer to repair the fistula through perineal route especially when urethral reconstruction is also required. The repaired ends of the fistula are separated with various interposition flaps and grafts in order to prevent recurrence. Gracilis interposition muscle flap is commonly used. We describe the first case of traumatic rectourethral fistula repair in a 45-year-old man using interposition of a porcine small intestinal submucosal (Biodesign™ (Surgisis(®)) graft.