@article{3210804,
    title = "Unusual Case of Urethrorectal Fistula in Adolescence in a Patient with a History of Congenital Anorectal Malformation.",
    author = "Nastos, Constantinos and Sotirova, Ira and Papatsoris, Athanasios and Skolarikos, Andreas and Papaconstantinou, Ioannis and Dellis, Athanasios",
    journal = "Journal of Endourology Case Reports",
    year = "2016",
    volume = "2",
    number = "1",
    pages = "24--26",
    doi = "10.1089/cren.2015.0042",
    abstract = "BACKGROUND: Urethrorectal fistula is a rare and debilitating condition. Spontaneous closure is rarely effective, and appropriate management regarding timing of repair  and surgical approach remains controversial. CASE PRESENTATION: We present a case of  an 18-year-old male found to have a urethrorectal fistula after diagnostic work up  for unejaculation. The patient gradually developed recurrent urinary tract  infections and urine and semen leak from his rectum. He had a medical history of an  anorectal reconstruction in the second postnatal day due to an anorectal  malformation. Imaging with a rectal endoscopic ultrasound scan revealed a  suprasphincteric urethrorectal fistula that was further confirmed with semirigid  urethrocystoscopy and placement of a nitinol guidewire through the urethral fistula  orifice. Its anal orifice was 3 cm above the anal verge at the 12th hour of the  rectum. The fistula orifice on the rectum was identified with a transanal approach  and the fistula was managed with the performance of an advancement mucosal flap and  bladder catheterization. The patient developed a recurrence with this approach and  finally underwent fistula ligation and reconstruction using a scrotal flap. The  patient has not had a recurrence of the fistula during his follow-up. CONCLUSION:  This is an unusual case of iatrogenic urethrorectal fistula as it presented in  adolescence many years from the initial operation of anorectal reconstruction and  with unusual symptoms."
}