Surgical treatment of a congenital malformation of the anorectal area: rectourethral fistula in children

Rectourethral fistula (RUF) is a variant of congenital anorectal malformation (СARM) in boys, characterized by abnormal connection of atretic rectum with urethra. Aim - to evaluate results of surgical treatment in boys with RUF, using a differentiated approach to diagnosis and treatment in isolated and associated forms. Materials and methods. The study included 20 boys: 10 with rectoprostatic fistula and 10 with rectobulbar, representing 13.0% of all treated anorectal anomalies (n=154). An isolated form was diagnosed in 10.0% (n=2) of children, while 90.0% (n=18) had an associated form, of which 3 (16.7%) were complicated. Results. At stage I, double-barrel separating colostomy was performed in 13 (65.0%) boys, double-barrel loop colostomy in 6 (30.0%) and final transversostomy in 1 (5.0%). In 2 children with esophageal atresia and lower tracheoesophageal fistula, separation of fistula and formation of primary esophageal anastomosis were performed after colostomy. In a child with duodenal atresia, an anastomosis was formed according to Kimura during colostomy removal. At stage II, posterior sagittal anorectoplasty was performed in 17 (85.0%) children; abdomino-perineal in 3 (15.0%), and in 1 (5.0%) child with sigmoid atresia, abdomino-perineal anorectoplasty with enterocyst, formation of transverse-sigmoid anastomosis and protective loop ascendostomy was performed. Stage III involved stoma closure in all patients. Conclusions. Comprehensive diagnostics in newborns with RUF allows to identify associated developmental defects, especially those requiring staged and simultaneous operations. A differentiated approach to diagnostics, anorectoplasty methods, rehabilitation yielded good results in 68.4% and satisfactory in 31.6% of children. The research was carried out according to principles of the Declaration of Helsinki, approved by Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research. No conflict of interest was declared by author.