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

• Published in: Journal of pediatric surgery case reports Vol. 79; p. 102237
• Main Authors: Cheung, Stephanie L.H., Hung, Judy W.S., Chung, Kenneth L.Y., Leung, Michael W.Y.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2022; Elsevier
• Subjects: Anorectal malformation; Epididymo-orchitis; Micturating cystourethrogram; Recto-urethral fistula; Urethral anomalies; Recto-urethral fistula; Urethral anomalies; Epididymo-orchitis; Micturating cystourethrogram; Anorectal malformation
• ISSN: 2213-5766; 2213-5766
• DOI: 10.1016/j.epsc.2022.102237

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.