Rectobladder Neck Fistula
A typical case of
rectobladder neck fistula.
Distal Colostogram
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In a rectobladder neck fistula, the rectum and the urinary tract do not share a common wall above the fistula, as in the
rectourethral bulbar fistula and the
rectourethral prostatic fistula.
The rectum and urinary tract connect in a rather T-fashion; therefore, paradoxically, in spite of the fact that there is a very high defect, the separation of rectum and bladder neck is much easier than in the case of the urethral fistula.
Remember, however, that the vasa deferentia usually open into the urinary tract almost at the same site as the rectum, thus, the surgeon must be very careful during this dissection and keep that in mind.
A good, high pressure distal colostogram should reveal precisely the type of defect present, and the operator must be prepared to approach the patient through a posterior sagittal incision as well as transabdominally or laparoscopically.
This will lengthen the procedure for about two more hours.
Attempting to find the rectum and dissecting it through the posterior sagittal approach in this type of specific defect, entails a risk of serious injury to the urinary tract.
It is not unusual to see ectopic ureters opening at the level of the bladder neck or posterior urethra that could be injured in a futile attempt to find the rectum.
Therefore, the importance of a good distal colostogram to disclose a rectobladder neck fistula cannot be overemphasized.
The operation used to repair this type of defect is called a Posterior Sagittal Anorectoplasty with Laparotomy or laparoscopy.
For more information or to request an appointment, please contact the Colorectal Center at Cincinnati Children's.
