2021 Volume 57 Issue 1 Pages 44-47
A 4-year-old boy with horseshoe kidney, vesicoureteral reflux, hydronephrosis and left-sided undescended testis was managed by the urology department at our institution. The appearance and position of the anal opening were normal, and the evacuation function worked well. He was referred to our department owing to the passage of urine through the anal opening during micturition. A retrograde urethrogram did not show the fistulous communication between the urethra and the anal canal. However, the persistence of symptoms and recurrent urinary tract infection (UTI) prompted the need for cystoscopy under general anesthesia. Initially, the communication was not visualized during cystoscopy, but a pigment injected through the cystoscope appeared to egress through the anal sinus. He was diagnosed as having “H-Type” ano-urethral fistula without an imperforate anus and underwent elective surgery. A guidewire placed through the tract with the aid of cystoscopy and a urethral catheter were helpful in confirming the presence of the tract during the procedure. A longitudinal skin incision was made along the perineal raphe with the patient in the lithotomy position. The anterior rectal wall was exposed until the proximal side from the fistulous tract was reached. The tract was divided. The urethral side was closed by double ligation, and the anal side was closed by layer-to-layer suturing. After the procedure, his QOL improved because he was able to urinate in the standing position, and fecal staining and UTI did not recur. Male “H-Type” ano-urethral fistula without an imperforate anus is very rare; therefore, knowledge of its diagnosis and operative method is limited. We reported the tips on these with previous studies.
