The effect of rectourogenital fistula in high imperforate anus.

To determine the incidence of rectourogenital fistulae and the possible role of fistulae on the mechanism of defecation in patients with high imperforate anus, we retrospectively studied 42 children, 38 males and four females, all with high imperforate anus presenting in the period from 1982 to 1995. All children underwent radiological evaluation, to determine the level of the rectal pouch 18-24 hours after birth and to study the bony spine. A preliminary colostomy was performed in all patients after the diagnosis shortly after birth. Ultrasonography was performed in all the cases to assess the kidneys and ureters. All patients but one was operated on via a posterior sagittal anorectoplasty. Bowel control was assessed clinically regarding the presence of voluntary bowel movement, fecal soiling, incontinence and constipation. Eighteen (42.8%) patients were found to have recto-urogenital fistulae; 15 rectourethral, two rectovaginal and one rectovesical. Outcomes were known for 36 out of 42 patients; 15(41.6 %) had voluntary bowel movements, nine (25 %) had soiling, six (16.6%) had constipation and six (16.6 %) had incontinence. In conclusion, the presence of rectourogenital fistula in patients with high imperforate anus is another new prognostic factor for anorectal function which needs further clarification.