Anatomy of the Rectourethral Fistula in ARM

Part of Anorectal Malformations 21 items

Infographic · Sep 2019 · 1 min read

In brief

This educational resource presents a standardized anatomic classification system for rectourethral fistulae in males with anorectal malformations, correlating distal colostogram findings with precise fistula levels. The classification guides surgical approach selection—posterior sagittal versus laparoscopic/open abdominal—improving preoperative counseling and outcomes stratification.

High-pressure distal colostogram is essential for visualizing recto-urethral fistulae but precise urethral communication level can be difficult to interpret
Fistula anatomy determines surgical approach: posterior sagittal incision vs abdominal laparoscopy/laparotomy
Standardized anatomic correlation between colostogram findings and fistula level aids family counseling and outcomes stratification
Recto-urethral fistulae are the most common presentation in males with anorectal malformations
Accurate preoperative fistula localization helps predict rectal reachability and optimize surgical planning

Written by the GCMD Library team from the infographic.

The infographic uses a blue background with three X-ray images on the left showing different fistula locations, and a central anatomical diagram illustrating bladder and rectal anatomy with labeled points A, B, and C. On the right is a bronze statue (Rodin's Saint John the Baptist) with the same anatomical points overlaid to demonstrate fistula locations. White arrows connect the diagram points to their corresponding locations.

Recto-urethral fistulae are the most common finding in males born with an anorectal malformation (ARM). A high pressure distal colostogram is an important tool in visualizing the fistula, although the precise level at which the fistula communicates with the urethra may be difficult to interpret and is not reported in a uniform manner. This anatomy affects the surgical plan; determining the likelihood that the rectum is reachable via a posterior sagittal incision or better approached through the abdomen via laparoscopy or laparotomy helps counsel families and stratifies diagnoses for outcomes work. This work presents a figure used at Nationwide Children's Hospital to assist with correlating findings on the distal colostogram with the anatomic level of the recto-urethral fistula in males with anorectal malformations.

Visual abstract created by Alejandra M Casar Berazaluce, MD - Pediatric Surgery Research Fellow at Cincinnati Children's Hospital Medical Center.

The text in the image

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