For malformations that involve the mixing of urine and feces, treatment will first focus on diverting the feces away from the urethra to prevent infection and other complications. This is accomplished through the creation of a colostomy, and regardless of the patient’s age, it is performed as soon as possible after the condition is diagnosed.
The colostomy redirects the end of the large intestine through an opening in the abdominal wall, allowing feces and intestinal mucus to pass into an external collection bag. If the colostomy is performed shortly after birth, the second phase of treatment will be performed after the patient has had a chance to grow.
The second phase of treatment will vary from patient to patient depending on the precise nature of the fistula. The procedure involves disconnecting the abnormal fistula from the urethra or bladder to the rectum, and then bringing the rectum down to a newly created anal opening precisely positioned within the sphincter muscle complex. These procedures can be performed either using minimally invasive techniques (laparoscopy) or an operation called the Posterior Sagittal Anorectoplasty (PSARP).
After the second surgery, feces will continue to leave the body through the colostomy for the next six to eight weeks while the pull-through heals. Once the pull-through is healed, a third surgery will be performed to close the colostomy so that feces will pass through the new anus.
The knowledgeable staff of the Cedars-Sinai Pediatric Bowel Management Program, Pediatric Surgery Services and Urology Program will work with each patient to determine the best treatment option.