Congenital posterior urethral fistula

　　This disease is usually due to the failure of the urogenital fold to close or fail to separate the urogenital sinus from the rectum during embryonic development, leading to communication between the urethra and rectum or perineum. It can be divided into the following 3 types:

　　1, Urethral rectal fistula with congenital anal-rectal atresia

　　The distal rectum becomes thin and communicates with the posterior urethra. Some are connected with the prostatic part of the urethra, and some are connected with the membranous part of the urethra. There is no anus, and meconium is excreted through the urethra, and congenital urethral stenosis may also occur concurrently, which is the most common type in clinical practice.

　　2, 'H' shaped urethral rectal fistula

　　The anal-rectum is normal, and there is a fistula between the posterior urethra and rectum,呈 'H' shape.

　　3, Posterior urethral perineal fistula

　　The fistula originates from the posterior urethra and communicates with the perineal skin.

　　Congenital urethral fistula is rare and is divided into anterior urethral fistula and posterior urethral fistula. Anterior urethral fistula is extremely rare, and posterior urethral fistula is more common, often complicated with rectal anal malformations. The specific complications of this disease are as follows:

　　1, Secondary infection

　　The skin of the perineum, buttocks, and inner thigh may develop varying degrees of dermatitis, rashes, and eczema due to long-term immersion in urine, causing local pruritus and burning pain. If scratched, secondary infection may occur, leading to boils. Urinary fistula patients may sometimes have varying degrees of urinary tract infection symptoms. If there is a ureteral fistula with local ureteral stenosis leading to renal pelvis expansion and hydrops, infection is more likely to occur. Some may first form retroperitoneal urinary extravasation, with concurrent infection, and then vaginal urine leakage, which occasionally occurs after radical hysterectomy for cervical cancer.

　　2, Secondary amenorrhea and infertility

　　About 1/2 to 1/3 of urinary fistula patients have secondary amenorrhea, but the cause of its occurrence is not yet clear. Some believe that it is due to the low ovarian function caused by mental factors, with no ovulation during urine leakage, and ovulation can resume after repair and cure, and menstruation can return. About 40% of urinary fistula patients have secondary infertility.

　　3, Mental and neurological symptoms

　　Patients with urinary fistula often dare not go out to participate in collective activities and labor, nor do they want to visit relatives and friends, which seriously affects their work and study. Those with vaginal scar stenosis or atresia lose sexual and reproductive ability, which also affects the couple's feelings and family relationships. Some patients cannot bear the long-term mental and physical torment, leading to depression, and even thoughts of suicide.

　　Congenital anal-rectal atresia can be diagnosed by the symptoms of urethral exhaust during urination, cloudy urine mixed with meconium. In addition to the above symptoms, the 'H' shaped urethral rectal fistula may also cause urinary retention, with urine excreted from the rectum in a watery stool. Due to the urine entering the rectum through the fistula, hyperchloremic acidosis may occur. Most patients have concurrent pyelonephritis, which recurs frequently. Perineal fistula, mainly manifested as urinary leakage in the perineum during urination, generally with a small fistula, urine flow not in a line, but in droplets, which can only be seen by careful observation. Some may present with a cystic bulge in the perineum during urination, with a small hole at the top leaking urine. The child may have lower urinary tract infection, but the harm is not great unless there is concurrent upper urinary tract malformation and vesicoureteral reflux.

　　This disease is formed during embryonic development, so pregnant women should pay attention to prevention during the embryonic period, consume adequate minerals and vitamins, and other nutrients. Pregnant women should also avoid contact with chemical substances, smoking and drinking, over-the-counter drugs, and maintain a cheerful mood.

　　Congenital posterior urethral fistula can be seen on micturating cystourethrography that the contrast agent enters the rectum, and the large fistula can be located by endoscopy. The small fistula is not easily seen by endoscopy. The 'H' fistula can be seen through rectoscopy or the depression at the fistula site, and the urine turns blue after rectal methylene blue enema.

　　Patients should pay attention to a light diet, eat more vegetables and fruits, quit smoking and drinking, eat less spicy and irritating foods, and the following are the dietary recipes for this disease.

　　Ingredients:Chinese wolfberry 50 grams, poria 100 grams, black tea 100 grams.

　　How to Make:Grind Chinese wolfberry and poria into coarse powder, take 5-10 grams each time, add 6 grams of black tea, and infuse with boiling water for 10 minutes.

　　Usage:Twice a day, as a tea.

　　Commentary: Chinese wolfberry is sweet and can nourish the kidney and essence, poria is sweet and light and can invigorate the spleen and promote diuresis, black tea can promote diuresis and invigorate the spirit. This recipe is an ideal beverage for treating difficulty in urination.

　　This disease has three types: urethral rectal fistula with anorectal atresia, H-shaped urethral rectal fistula, and posterior urethral perineal fistula. Different treatment methods are adopted according to its type.

　　1. Urethral Rectal Fistula with Anorectal Atresia:: Perform colostomy first, and perform suprapubic vesicostomy at the same time if necessary. Perform rectal urethral separation surgery, repair the fistula, and perform analoplasty when older and able to withstand larger surgeries.

　　2. H-shaped Urethral Rectal Fistula: Perform colostomy and suprapubic vesicostomy first, and then excise the fistula through the perineum in the second stage, and repair the posterior urethra and rectum separately.

　　3. Posterior Urethral Perineal Fistula: Excise the fistula through the perineum, and perform a temporary vesicostomy at the same time.