Diagnosis and conservative treatment of tubercular rectoprostatic fistula.
OBJECTIVE
To present our experience with three cases of rectoprostatic fistula with special emphasis on diagnosis and conservative management.


METHODS
Three middle-aged men presented to us differently. All had spontaneous rectoprostatic fistulas. Biopsy showed tuberculosis though three consecutive urine samples for acid-fast bacilli were negative. None of the patients were immunocompromised. Their upper tracts were normal and all had a past history of pulmonary tuberculosis. They were started on antitubercular drugs and urinary diversion with or without faecal diversion.


RESULTS
All fistulae healed completely within 6 weeks of starting antitubercular treatment. One patient healed with bladder neck stenosis that required bladder neck incision. Voiding was normal on 1-year follow-up.


CONCLUSIONS
Spontaneous tubercular rectoprostatic fistulae are rare. There should be a strong clinical suspicion in endemic areas. Prostatic biopsy proves the diagnosis. Conservative management with antitubercular drugs and urinary diversion with or without faecal diversion has a high success rate and should be the first line of treatment even if urine is negative for acid-fast bacilli.
Kumar
Santosh
S
Department of Urology, Christian Medical College, Vellore, Tamilnadu, India.
Kekre
Nitin S
NS
Gopalakrishnan
Ganesh
G
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005402:Fistula / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011469:Prostatic Diseases / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D012003:Rectal Fistula / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D016896:Treatment Outcome; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis / Q000188:drug therapy*; D014401:Tuberculosis, Urogenital / Q000175:diagnosis / Q000188:drug therapy*; D014547:Urinary Diversion / Q000379:methods
D000995:Antitubercular Agents