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[A case of urethrorectal fistula]
K Murayama1, T Katsumi, S Douba
1Department of Urology, Kanazawa National Hospital.
This case report describes the diagnosis and surgical treatment of a rare condition called a urethrorectal fistula in a 59-year-old man. The patient had symptoms of diarrhea and frequent urination. Doctors used imaging and endoscopic techniques to locate the fistula, which connected the urethra and rectum near the external urethral sphincter. The surgery involved removing the prostate and the fistula, closing the rectal wall, and reconnecting the urethra to the bladder. The operation was successful, and the patient recovered well. The authors highlight the importance of accurate diagnosis and the effectiveness of this surgical approach.
Area of Science:
- Urological surgery
- Gastrointestinal anomalies
- Reconstructive surgery
Background:
Urethrorectal fistulas are rare conditions that connect the urethra and the rectum. Prior research has documented such fistulas in association with trauma, infection, or congenital defects. However, the exact mechanisms leading to their formation remain unclear. No prior work had resolved the optimal surgical approach for these cases. Existing literature suggests that diagnosis often requires a combination of imaging and endoscopic techniques. The challenge lies in identifying the fistula's location and extent before attempting repair. Patients typically present with urinary and gastrointestinal symptoms. This gap motivated the investigation of a case involving a 59-year-old man with a confirmed urethrorectal fistula.
Purpose Of The Study:
The aim of this case report is to describe the clinical presentation and surgical management of a urethrorectal fistula. The specific problem addressed is the diagnostic and therapeutic complexity of such fistulas. The motivation stems from the need to share a successful surgical approach. This case provides insight into the challenges of preoperative evaluation and intraoperative decision-making. The authors sought to document the step-by-step surgical technique used. They also aimed to highlight the importance of accurate imaging and endoscopic findings. The report contributes to the limited literature on this condition. It serves as a reference for urologists and colorectal surgeons encountering similar cases.
Main Methods:
The patient underwent retrograde urethrography to visualize the fistula's location. Urethroscopy was used to confirm the presence of the fistula and assess its size. A urethral pressure profile was conducted to evaluate sphincter function. These diagnostic tools helped determine the fistula's proximity to the external urethral sphincter. The surgical approach was planned through an abdominal incision. Total prostatectomy was performed to access the fistula. The fistula was resected under direct vision to ensure complete removal. The anterior rectal wall was closed, and a urethrovesical anastomosis was created.
Main Results:
The surgical repair was completed without complications. The fistula was successfully resected, and the anastomosis was performed. Postoperative recovery was uneventful, and the patient showed no signs of recurrence. The urethral pressure profile indicated normal sphincter function. The closure of the rectal wall prevented further contamination. The anastomosis between the urethra and bladder neck was secure. Follow-up imaging confirmed no residual fistulous tract. The patient was discharged with a satisfactory functional outcome.
Conclusions:
The authors propose that an abdominal approach is suitable for urethrorectal fistula repair. They suggest that total prostatectomy facilitates direct visualization of the fistula. The closure of the anterior rectal wall is essential for preventing recurrence. The anastomosis between the urethra and bladder neck should be carefully performed. The use of retrograde urethrography and urethroscopy is recommended for accurate diagnosis. The authors emphasize the importance of multidisciplinary collaboration. They suggest that early surgical intervention may improve outcomes. The case demonstrates the feasibility of this surgical approach.
Frequently Asked Questions
A urethrorectal fistula is an abnormal connection between the urethra and the rectum. It allows the passage of urine and feces between these structures.
Retrograde urethrography, urethroscopy, and urethral pressure profiling were used to locate and assess the fistula.
Total prostatectomy was performed to access the fistula and facilitate its complete resection under direct vision.
The urethral pressure profile helped evaluate the function of the external urethral sphincter before surgery.
The surgical repair was successful, with no recurrence and normal postoperative function.
The authors suggest that an abdominal approach with total prostatectomy is suitable for this type of fistula repair.