Anatomy of the Rectourethral Fistula in ARM

Part of Anorectal Malformations 21 items

Infographic · Sep 2019 · 1 min read

In brief

Educational resource presenting a standardized anatomic classification system for rectourethral fistulae in males with anorectal malformations. Correlates distal colostogram findings with precise fistula level to guide surgical approach selection between posterior sagittal and abdominal techniques.

High-pressure distal colostogram is essential for visualizing recto-urethral fistulae in males with ARM, though fistula level interpretation varies.
Anatomic level of the recto-urethral fistula determines surgical approach: posterior sagittal incision vs. laparoscopic/laparotomy access.
Standardized imaging correlation tools improve preoperative planning, family counseling, and outcomes stratification for ARM repair.
Recto-urethral fistulae are the most common presentation in males with anorectal malformations requiring precise anatomic assessment.
Uniform reporting of fistula anatomy is needed to optimize surgical decision-making and compare outcomes across institutions.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, with accompanying text boxes below describing outcomes. The left column shows balloon dilation, the middle shows Heller myotomy, and the right shows POEM procedure. Success rates are prominently displayed with percentage figures.

Recto-urethral fistulae are the most common finding in males born with an anorectal malformation (ARM). A high pressure distal colostogram is an important tool in visualizing the fistula, although the precise level at which the fistula communicates with the urethra may be difficult to interpret and is not reported in a uniform manner. This anatomy affects the surgical plan; determining the likelihood that the rectum is reachable via a posterior sagittal incision or better approached through the abdomen via laparoscopy or laparotomy helps counsel families and stratifies diagnoses for outcomes work. This work presents a figure used at Nationwide Children's Hospital to assist with correlating findings on the distal colostogram with the anatomic level of the recto-urethral fistula in males with anorectal malformations.

Visual abstract created by Alejandra M Casar Berazaluce, MD - Pediatric Surgery Research Fellow at Cincinnati Children's Hospital Medical Center.

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