Timothy F Tirrell, MD, PhD
Timothy F Tirrell, MD, PhD; Farokh R Demehri, MD; Prathima Nandivada, MD; Erin R McNamara, MD, MPH; Belinda H Dickie, MD, PhD; Boston Children's Hospital
Congenital rectourethral fistula a well-recognized anorectal malformation. Repair is generally performed in the infant period, although sometimes delayed into childhood due to associated comborbidities or social situations. We recently encountered a 17 year old male patient with an unrepaired rectourethral fistula. We elected to repair this using a combined abdominal and perineal approach, with robotic assistance for abdominal and deep pelvic dissection.
Considerations for operative repair for this patient are different from repair in an infant or child. Simultaneous urethroscopic evaluation helps identify the true origin of the fistula and minimize the potential of a posterior urethral diverticulum. The robotic system is helpful for dissection of deep pelvic structures in this large patient, and for visualizing the location of the cystoscope. Lastly, performing the anoplasty in lithotomy position is challenging but eliminates the need to change to prone positioning for perineal work, which is helpful in this adult sized patient.