Ainize Ibarzabal (Gastrointestinal Surgery Senior Specialist)
Raul Almenara (Gastrointestinal surgery senior specialist)
Victor Turrado (Gastrointestinal Surgery Specialist)
Hospital Clínic, Barcelona – Spain
A 48-year-old male with a previous history of positive HIV, controlled with antiretroviral treatment (ARVT), and the human papilloma virus (HPV), which caused a low-grade anal intraepithelial neoplasia (AIN-1) that was successfully resected in 2014.
He was being followed by the infectologist due to persistent urinary tract infection with positive test results for Escherichia coli and Klebsiella pneumoniae cultures. The patient described occasional pneumaturia and fecaluria. As an uro-digestive fistula was suspected, several studies were performed. CT scan results were normal, a trans anal prostatic ultrasound was unspecific, and a urethro-cystoscopy and an ascending urethrocystography were unable to detect any abnormal communication between the urinary and digestive tract.
The patient continued to have recurrent urinary tract infection episodes. Further study was carried with pelvic MRI that finally identified the problem: a fistula between the prostatic urethra and the lower rectum having an intersphincteric tract (VID1).
The patient was advised to undergo a York-Mason procedure but he refused the procedure. At that time he preferred a diverting stoma, after which he would consider to undergo the curative procedure.
A loop colostomy of the transverse colon was built at the left flank, and mobilization was accomplished laparoscopically with a total of three trocars.
Operative time was 90 minutes. The surgery was uneventful and the patient left hospital one day after the surgical procedure.
VID 1. Recto – urethral fistula