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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
video1:45:12 · 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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Laparoscopic Surgery for Male Imperforate Anus and Rectourethral Fistula:...
In rectourethral fistula repair, dissection must extend to the red line (urethral orifice) to prevent residual fistula, while avoiding injury to nerves, prostate, urethra, and sphincters.
clinicalYamataka0:21 ↗
A novel technique measures fistula length using a calibrated catheter, allowing the surgeon to know exactly how far to safely dissect distally for complete cyst excision.
clinicalYamataka0:33 ↗
In a series of 29 male patients with imperforate anus, 23 had rectourethral fistula (14 prostatic, 9 bulbar) and were studied using the new measurement technique.
epidemiologicalYamataka0:51 ↗
During laparoscopic fistula dissection, a fine flexible colonoscope inserted into the anterior rectal wall allows both the fistula orifice and the level of laparoscopic dissection to be observed intraluminally.
clinicalYamataka1:52 ↗
A fine catheter with calibration is inserted through the fistula opening by the laparoscopic surgeon while another surgeon performing cystoscopy observes how far it emerges at or near the verumontanum, allowing measurement of the inside length of the fistula.
clinicalYamataka2:37 ↗
If the length of the residual fistula is longer than 5 millimeters, the rectal end is further dissected toward the urethra using mucosectomy to prevent injury to the prostate and urethra.
clinicalYamataka4:27 ↗
The dissection procedure is repeated until the length of the residual fistula is shorter than or equal to 5 millimeters, then the fistula is ligated, tied, and excised.
clinicalYamataka4:57 ↗
For bulbar fistula repair, it is very important to obtain a clear surgical field of the deep pelvic floor; this is achieved through use of a tube cystostomy which decompresses the bladder and opens up a clear view.
clinicalYamataka6:16 ↗
Trocar position for rectal bulbar fistula differs from prostatic fistula in that right and left trocars are placed much closer to the telescope, which is key for bulbar fistula repair.
clinicalYamataka6:49 ↗
A new device allows the telescope to be adjusted to face any direction from 0 to 120 degrees intraoperatively, allowing the surgeon freedom to choose the best view without disrupting dissection.
clinicalYamataka7:10 ↗
Despite increased difficulty in handling forceps with closer trocar positioning, it allows the tips of the forceps to reach deeper and to reach the bulbar urethra, which is located deep in the pelvis.
clinicalYamataka7:32 ↗
After the fistula is tied, a catheter is again inserted until it gently probes the tied fistula, allowing the surgeon to reconfirm that the residual fistula length is shorter than or equal to 5 millimeters.
clinicalYamataka8:30 ↗
In the first 8 cases, initial measurements of rectal to urethral orifice showed fistula lengths of 13, 15, 12, 10, 15, 21, 10, and 5 millimeters respectively; 7 cases required further dissection until the fistula was ≤5 mm, but case 8 did not require further dissection.
epidemiologicalYamataka9:25 ↗
During cystoscopy, normal saline refluxed into the pelvic floor through the fistula in 6 cases (indicating a large fistula), but there was no reflux in 2 cases (indicating a very narrow fistula).
clinicalYamataka9:48 ↗
All 23 cases were well after mean follow-up of 2 years, with no evidence of diverticular formation owing to residual fistula on voiding cystourethrography or MRI.
epidemiologicalYamataka10:10 ↗
All dissections were uncomplicated and postoperative courses were unremarkable.
epidemiologicalYamataka10:20 ↗
The residual fistula from rectal site to urethral side is much longer than expected.
clinicalYamataka10:28 ↗
The new technique measuring the exact length of the fistula facilitates safe and complete excision of the fistula, reducing the risk of postoperative diverticulum formation due to incomplete fistula excision.
opinionYamataka10:37 ↗
For prostatic fistula dissection, if the laparoscopic surgeon has training in fundamental techniques like gallbladder removal, they can perform the procedure.
opinionYamataka13:10 ↗
The key for dissection of the fistula is decompression of the bladder; if the laparoscopic surgeon's technique is not good enough, inserting a suprapubic catheter first for complete decompression provides a good view of the pelvic floor.
clinicalYamataka13:31 ↗
For bulbar fistula dissection, a laparoscopic surgeon needs 5 to 10 cases of prostatic fistula experience before they can challenge bulbar fistula.
opinionYamataka14:32 ↗
For bulbar fistula, the trocar position must be very close to the telescope; otherwise the tip of the instrument cannot reach the deep side of the pelvis or the bulbar fistula.
clinicalYamataka14:43 ↗
Traction sutures (2 to 3) using laparoscopic hair closure needles are used to bring the bladder up during the procedure.
clinicalYamataka15:49 ↗
Right transverse colostomy is preferred because sigmoid colostomy can fix the rectum and colon, requiring takedown of the sigmoid colostomy to achieve enough length for pull-through of the distal end of the fistula.
opinionYamataka16:24 ↗
If sigmoid colostomy is done very proximal in the sigmoid or at the descending colon-sigmoid junction, there will be enough length to do a pull-through even for a high fistula.
opinion17:19 ↗
Laparoscopy can be used to help make the initial colostomy, allowing the surgeon to see exactly where they are.
clinicalJose18:00 ↗
A left lower quadrant transverse incision can be made to pull out the sigmoid and determine which end is which, then go proximal for colostomy placement.
clinical18:18 ↗
Transverse colostomy has too many problems including urine absorption, infection, and prolapse.
opinionSherif Emil18:37 ↗
With sigmoid colostomy on the left side, it is possible to place ports and work around the stoma without having to take it down for deep pelvic dissection.
clinicalJose19:17 ↗
With closer midline port positioning for bulbar fistulas, sigmoid colostomy location becomes less of an issue.
opinionJose19:42 ↗
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