Intraoperative measurement of rectourethral fistula: prevention of incomplete excision in male patients with high-/intermediate-type imperforate anus.
BACKGROUND
We report a novel technique to measure the length of the rectourethral fistula (RUF) in male patients with high-/intermediate-type imperforate anus during laparoscopically assisted anorectal pull-through (LAARP) to prevent incomplete excision.


METHODS
During LAARP for RUF in 5 male patients (mean age, 4.6 months; prostatic in 3, bulbar in 2), the RUF was dissected carefully close to the urethra and opened; and a fine catheter with 10-mm calibrations was inserted by the laparoscopic surgeon until it was seen to emerge at or near the verumontanum by another surgeon performing cystoscopy. The laparoscopic surgeon then measured the distance from the point where dissection was ceased at the rectal end to the urethral orifice. The RUF was dissected free from the prostate for exactly this length, tied, and excised; and colon pull-through was performed to finish LAARP.


RESULTS
Rectourethral fistulae ranged from 5 to 15 mm and were much longer than expected. All dissections were uncomplicated without any injury to the urethra, and postoperative courses were unremarkable. At mean follow-up of 11 months, urination is normal in all without evidence of residual fistula.


CONCLUSIONS
Knowing the exact length of the RUF facilitates safe and complete excision in an otherwise blind situation.
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Hiroyuki
H
Koga
Yoshifumi
Y
Kato
Akihiro
A
Shimotakahara
Go
G
Miyano
Geoffrey J
GJ
Lane
Tadaharu
T
Okazaki
Atsuyuki
A
Yamataka
D001006:Anus, Imperforate / Q000473:pathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000379:methods; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012003:Rectal Fistula / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000473:pathology / Q000601:surgery*