Endoscopic management of infected enlarged prostatic utricles and remnants of rectourethral fistula tracts of high imperforate anus.

Abstract

Infected enlarged prostatic utricles and infected remnant fistula tracts of high imperforate anus are usually managed by a suprapubic, transtrigonal or posterior sagittal approach. We describe a minimally invasive endoscopic approach to these entities. We treated 12 patients with infected enlarged prostatic utricles and 4 with infected remnant fistula tracts using endoscopic techniques. Specifically a resectoscope with a bulb electrode or a cystoscope with a Bugby electrode was used to fulgurate circumferentially the dilated utricle or remnant fistula. After fulguration a Councill catheter was placed in the lesion for 3 to 5 days and urine was diverted via a suprapubic tube for 2 to 3 weeks. Obliteration of the abnormality was verified by a voiding cystourethrogram. Using this technique median postoperative hospital stay was 2 days (range 0 to 7). The enlarged prostatic utricle or remnant fistula tract was completely obliterated in 87% of the cases (62% after 1 and 25% after 2 treatments). Of our patients 13% had a significant (greater than 50%) decrease in utricular cyst size although a urethral abnormality persisted. Postoperative morbidity was minimal. One patient (6%) had a fever for 3 days postoperatively and none has had a urethral stricture during a median followup of 2 years (range 3 months to 4 years). Although it is not a panacea, electrofulguration of an enlarged prostatic utricle and/or remnant fistula of imperforate anus is a simple procedure that has a high rate of success, does not require prolonged hospitalization and is associated with minimal morbidity.