Congenital Rectovesical Fistula and its Associated Anomalies

Abstract

A series of II specimens of congenital rectovesical fistula is presented, illustrating the constant association of major genito‐urinary defects with this rare anomaly. Abnormalities of the vertebral column, pelvis and pelvic floor are also frequently associated with the condition.

Penislike clitorises with megalourethras in nonvirilized female fetuses and a newborn. A histopathologic study and its bearing on their pathogenesis

“…This combination of features favors the designation "penislike clitoris" with the presence of a central urogenital canal ("phallic urethra") as an essential morphological difference in comparison with the true enlarged clitoris, which is characterized by the opening of a persistent urogenital sinus (cloaca) at its base [4,6,29,30].…”

“…This disorder is also characterized by maletype external genitalia, but in this category, most phallic structures are penislike, well-developed scrotums are uncommon, and the deformation is associated with other anomalies of the perineum. The penislike clitorises are occasionally part of a spectrum of multiple caudal anomalies that are considered to result from lower mesodermal defects [1,2,[5][6][7][8][9][10][11][12]. They are a consistent feature of accessory phallic urethra duplication [13][14][15][16][17][18][19][20][21][22][23] that was presumed to result from a temporary and regional masculinization during fetal development [14,17].…”

The various types of anorectal fistula in male imperforate anus

“…At the conclusion of her paper, Magnus [8] states that "a congenital rectovesical fistula is always associated with severe anomalies of the urinary tract," a conclusion Fig.2 Diagram of the four types of short colon syndrome according to Narsimharao et al [11], based on the length of the colon which is present and described in the text which has been accepted by subsequent authors, including Stephens and Smith [1 (p.37), 2 (p.38)], who state that vesical fistulas are rare and are generally associated with serious and often lethal abnormalities of the urinary tract, spine, and other organs. This concept that IA with a rectovesical fistula is always or generally associated with abnormal urinary tract, in large part due to the highly selected material in Magnus' paper [8], should be modified somewhat.…”

“…Three forms may be considered: a simple and relatively benign form, the cases reported by Magnus [8], and IA with a rectovesical fistula associated with a short colon. In all types the fistula usually ends in the trigone of the bladder, often near the bladder neck.…”

“…This concept that IA with a rectovesical fistula is always or generally associated with abnormal urinary tract, in large part due to the highly selected material in Magnus' paper [8], should be modified somewhat. The cases of simple, benign male IA with rectovesical fistula seen in our hospital (see above) and the innumerable cases of IA with a rectovesical fistula and a short colon to be discussed next, in which urinary tract anomalies are not overwhelming, would support this opinion.…”