Prenatal Diagnosis and Management of Isolated Recto-Urethral Prostatic Fistula: A Case Report

Document Type : Case Report

Authors

Department of Pediatric Surgery, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia

Abstract

Background: Recto-urethral prostatic fistula (RUPF) is a rare form of anorectal malformation (ARM). Its prenatal diagnosis and management with a minimum consequence are challenging. This study aimed to present diagnostic and therapeutic modalities in a patient with RUPF.
Case report: A 32-year-old pregnant woman with no relevant medical or surgical history at 27 weeks of gestation was referred to our department of pediatric surgery. Prenatal ultrasound showed loop dilatations and enterolithiasis. Fetal magnetic resonance imaging (MRI) imaging confirmed the diagnosis of ARM and suggested the presence of a recto-urinary fistula. There was no other associated malformation. Parents decided on the continuation of pregnancy after counseling. A 2300 g male was born at 37 weeks of gestation in February 2019. Colostomy followed by laparoscopic pull-through were performed. Expectations of the physician and parents were met after a one-year follow-up period.
Conclusion: Fetal MRI had the potential to diagnose ARM more accurately than ultrasound. Moreover, laparoscopic pull-through was safe and feasible.
 
 

Keywords


  1. Bischoff A, Levitt MA, Peña A. Update on the management of anorectal malformations. Pediatr Surg Int. 2013; 29(9):899-904.
  2. Shimaru T, Kawashima H, Hayashi K, Omata K, Sanmoto Y, Inoue M. Laparoscopically assisted anorectoplasty-Surgical procedures and outcomes: a literature review. Asian J Endosc Surg. 2020; In Press.
  3. Blask AN, Fagen K. Prenatal imaging of the gastrointestinal tract with postnatal imaging correlation. Ultrasound Q. 2016; 32(1):15-24.
  4. Alamo L, Meyrat BJ, Meuwly JY, Meuli RA, Gudinchet F. Anorectal malformations: finding the pathway out of the labyrinth. Radiographics. 2013; 33:491-512.
  5. Bischoff A, Peña A, Levitt MA. Laparoscopic-assisted PSARP - the advantages of combining both techniques for the treatment of anorectal malformations with recto-bladderneck or high prostatic fistulas. J Pediatr Surg. 2013; 48(2):367-71.
  6. Han Y, Xia Z, Guo S, Yu X, Li Z. Laparoscopically assisted anorectal pull-through versus posterior sagittal anorectoplasty for high and intermediate anorectal malformations: a systematic review and meta-analysis. PLoS One. 2017; 12(1):e0170421.
  7. Ammar S, Sellami S, Zouari M, Zitouni H, Mansour MB, Hbaieb M, et al. Single-site laparoscopic management of complicated paraovarian cyst. Gynecol Minim Invasive Ther. 2019; 8(1):46-47.
  8. Correia P, Moreira M, Rodrigues M, Inocêncio G. Prenatal diagnosis of vesicorectal fistula. Ultrasound Q. 2017; 33:112-4.
  9. Liberty G, Bardin R, Gilboa Y, Tover A, Mashiach R, Mazaki E, et al. First trimester expression of anorectal malformation: case report and review of the literature. J Clin Ultrasound. 2018; 46:591-7.
  10. Mallmann MR, Reutter H, Gottschalk I, Geipel A, Berg C, Gembruch U. Prenatal diagnosis of enterolithiasis in 20 cases. Fetal Diagn Ther. 2019; 46(4):266-73.
  11. Perlman S, Bilik R, Leibovitch L, Katorza E, Achiron R, Gilboa Y. More than a gut feeling - sonographic prenatal diagnosis of imperforate anus in a high-risk population. Prenat Diagn. 2014; 34(13):1307-11.
  12. Podberesky DJ, Towbin AJ, Eltomey MA, Levitt MA. Magnetic resonance imaging of anorectal malformations. Magn Reson Imaging Clin N Am. 2013; 21:791-812.
  13. Georgeson KE, Inge TH, Albanese CT. Laparoscopically assisted anorectal pull-through for high imperforate anus--a new technique. J Pediatr Surg. 2000; 35(6):927-30.
  14. Ichijo C, Kaneyama K, Hayashi Y, Koga H, Okazaki T, Lane GJ, et al. Midterm postoperative clinicoradiologic analysis of surgery for high/ intermediate-type imperforate anus: prospective comparative study between laparoscopy-assisted and posterior sagittal anorectoplasty. J Pediatr Surg. 2008; 43(1):158-62.
  15. Kudou S, Iwanaka T, Kawashima H, Uchida H, Nishi A, Yotsumoto K, et al. Midterm follow-up study of high-type imperforate anus after laparoscopically assisted anorectoplasty. J Pediatr Surg. 2005; 40(12):1923-6.
  16. Son J, Kim W, Jung SM, Lee S, Seo JM. Minimal dissection of posterior wall of rectum reduces rectal prolapse in laparoscopic assisted anorectal pull-through. J Pediatr Surg. 2020; 55(9):1969-73.
  17. Tran QA, Nguyen LT, Pham HD, Nguyen TTN, Nguyen XV. Follow-up outcomes of laparoscopic-assisted anorectal pull through for anorectal malformations of high type. J Laparoendosc Adv Surg Tech A. 2019; 29(11):1497-500.