Congenital Recto-Urethral Fistula and Recto-Bladder Neck Fistula

Recto-urethral fistulas and recto-bladder neck fistulas are types of anorectal malformations (ARMs) that affect males.

A recto-urethral fistula is characterized by the abnormal connection of the urethra to either the anus or rectum. This results in both solid waste and urine emptying from the body through the urethra.

A recto-bladder neck fistula, sometimes referred to as a rectovesical fistula, is one of the least common ARMs seen in male patients. The condition is characterized by a connection between the rectum and the bladder, which can cause urine and feces to mix and empty out of the urethra.

Both conditions are congenital, meaning from birth.

Symptoms

At present, there is no way to determine if the child has an anorectal malformation prior to birth. Children born with the condition may exhibit the following symptoms after birth:

  • Not passing feces the first day or two after birth
  • Passing feces through another opening such as the urethra
  • Swollen belly
  • Repeated urinary tract infections


Causes and Risk Factors

Recto-urethral fistula and recto-bladder neck fistula conditions are found exclusively in male patients.

The cause of congenital anorectal malformations is unknown, although environmental factors such as drug use during pregnancy may play a part.

Diagnosis

When infants are born with the condition, an initial physical exam will include examination of the anus to make sure it is open and in the correct position. When a male patient passes feces through the urethra or develops urinary tract infections, the physician will perform a detailed investigation.

Proper diagnosis of anorectal malformations has greatly improved with the use of diagnostic imaging tools such as magnetic resonance imaging (MRI), which may allow the medical team to view the fistula. Additionally, abdominal X-rays and abdominal ultrasounds may be done to aid in the diagnosis.

Treatments

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.