Rectourethral Fistula
Everything in the library about rectourethral fistula — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Fundamentals
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ARMs in Neonates: Pediatric Colorectal Controversies 2014
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Half day symposium, led by worldwide opinion leaders highlighting new concepts and controversies in pediatric colorectal anomalies. This symposium will address common controversies that pediatric surgeons face day to day in the treatment of
video105:12 · Jan 2019
Surgical Management
3 items
Laparoscopic Surgery for Male Imperforate Anus and Rectourethral Fistula:...
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During the Pediatric Surgery Tricks of the Trade and Difficult Cases: Innovative Solutions to Common Problems Course in 2013,Dr. Atsuyuki Yamataka discusses laparoscopic surgery for male imperforate anus and rectourethral fistula. Presentat
video25:00 · Sep 2018
Tricks - Imperforate Anus and Rectourethral Fistula
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Dr. Atsuyuki Yamataka discusses laparoscopic surgery for male imperforate anus and rectourethral fistula. Presentation discussion topics include measuring the residual fistula, thoracoscopic repair, and preoperative gap assessment.
video45:32 · Nov 2018
Imperforate Anus & Rectourethral Fistula Technique & Discussion: Difficult Cases
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Dr. Atsuyuki Yamataka discusses laparoscopic surgery for male imperforate anus and rectourethral fistula.
video25:05 · Jan 2019
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Tricks - Imperforate Anus and Rectourethral Fistula
Dissection of the fistula up to the red line is necessary to prevent residual fistula without injuring nerves, prostate, urethra, and sphincters
clinical0:21 ↗
23 male patients with rectourethral fistula were studied: 1 vesical, 14 prostatic, 9 bulbar, 5 no fistula
clinical0:51 ↗
A fine flexible colonoscope inserted into anterior rectal wall allows observation of both fistula orifice and level of laparoscopic dissection intraluminally
clinical1:52 ↗
A calibrated catheter inserted through the fistula opening while another surgeon performs cystoscopy allows measurement of inside fistula length between rectal opening and urethral orifice
clinical2:37 ↗
If residual fistula length is longer than 5mm, the rectal end is further dissected toward urethra using mucosectomy to prevent injury of prostate and urethra
clinical4:27 ↗
The measurement and dissection procedure is repeated until residual fistula length is ≤5mm, then fistula is ligated and excised
clinical4:57 ↗
For bulbar fistula, tube vesicostomy to decompress bladder is very important to obtain clear surgical field of deep pelvic floor
clinical6:16 ↗
For bulbar fistula, right and left trocars are placed much closer to telescope compared to prostatic fistula, which is key for reaching deep pelvic structures
clinical6:49 ↗
After fistula is tied, catheter is reinserted to gently probe tied fistula, allowing surgeon to reconfirm residual fistula length is ≤5mm
clinical8:30 ↗
In first 8 cases, initial fistula measurements from rectal to urethral orifice ranged from 5-21mm; 7 cases required further dissection, 1 did not
clinical9:25 ↗
During cystoscopy, normal saline refluxed into pelvic floor through fistula in 6 cases (indicating large fistula), but no reflux in 2 cases (indicating very narrow fistula)
clinical9:48 ↗
All 23 cases had no evidence of diverticular formation due to residual fistula on voiding urethrography or MRI after mean 2-year follow-up
clinical10:10 ↗
The residual fistula from rectal site to urethral site is much longer than expected
clinical10:28 ↗
Sigmoid colostomy placed very proximal in sigmoid or at descending-sigmoid junction provides enough length for pull-through even for high fistula
clinical17:19 ↗
Transverse colostomy has too many problems including urine absorption, infection, and prolapse
opinion18:37 ↗
With sigmoid colostomy, it is possible to place ports and work around stomas without taking them down for deep pelvic dissection
clinical19:14 ↗
For prostatic or bladder neck fistula, dissection can be done without the measurement technique and get very close to end of fistula
opinion20:21 ↗
For bulbar fistula, the measurement technique is still needed
opinion20:41 ↗
The laparoscopic approach for bulbar fistula is far more difficult and dangerous; PSARP technique is easy for those patients
opinion20:55 ↗
There is no convincing data that laparoscopic approach results in better outcomes for bulbar fistulas than PSARP
opinion21:20 ↗
Combining VCUG and colostogram with dye from both sides usually allows clear visualization of fistula
clinical23:41 ↗
Empty bladder is critically important when doing laparoscopic anorectal malformation repair
clinical23:51 ↗
Foley catheter placed at case start may go into fistula and rectum rather than bladder, which may not be discovered until mid-operation
clinical24:04 ↗
Cystoscopy at case start is advisable to ensure catheter is in bladder before starting
clinical24:22 ↗
Tube vesicostomy is needed to decompress bladder during cystoscopy, otherwise bladder fills with saline and obscures pelvic floor view
clinical24:33 ↗
For thoracoscopic TEF repair, gap between proximal and distal esophagus should be checked preoperatively
clinical26:21 ↗
Bronchoscopy by anesthesiologist can identify fistula orifice; X-ray taken with bronchoscope stopped at orifice shows gap distance (approximately one vertebra in presented case)
clinical26:49 ↗
Leaving one quarter of fistula uncut prevents distal esophagus from retracting cranially and makes anastomosis easier
clinical28:00 ↗
Leaving 12-15% of proximal esophageal tip uncut provides a 'cap' to grab with forceps rather than grabbing anastomotic site
clinical29:02 ↗
If there is 1-3 vertebra gap, assistant can pull proximal esophagus caudally using the uncut cap
clinical29:43 ↗
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