Gupta Ashok Kumar, Kumar Manoj, Singh Kawaljit, Sokhal Ashok Kumar
Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.
BMJ Case Rep. 2017 Feb 24;2017:bcr2016217331. doi: 10.1136/bcr-2016-217331.
A 24-year-old man presented with symptoms of difficulty in passage of urine, mixed with gas and stool from penoscrotal junction since birth. He had a history of surgery (posterior sagittal anorectoplasty) for imperforate anus in first week of his life. On physical examination, external meatus was adequate with small 5×5 mm fistulous opening noted at penoscrotal junction with normal anal tone and opening. On evaluation with retrograde urethrography, voiding cystourethrogram, cystoscopy and barium enema, he was found to have penile urethrocutaneous fistula of 0.5×0.5 cm with Y-type incomplete urethral duplication. Urethroanal fistula (Y-type urethral duplication) was of small size (<5 mm), so closed primarily through perineal route with interposition of ischiorectal fat. Penile urethrocutaneous fistula (4 mm) too was closed primarily and covered with tunica vaginalis flap in single sitting. It has been 6 months since surgery and the patient is fully continent and voiding well with no urinary or faecal leak.
一名24岁男性自出生以来出现排尿困难症状，伴有来自阴茎阴囊交界处的气体和粪便混合排出。他在出生后第一周接受过肛门闭锁手术（后矢状位肛门直肠成形术）。体格检查时，尿道口正常，在阴茎阴囊交界处可见一个5×5毫米的小瘘口，肛门张力和开口正常。经逆行尿道造影、排尿性膀胱尿道造影、膀胱镜检查和钡剂灌肠评估，发现他患有0.5×0.5厘米的阴茎尿道皮肤瘘，伴有Y型不完全尿道重复畸形。尿道肛门瘘（Y型尿道重复畸形）较小（<5毫米），因此经会阴途径将坐骨直肠脂肪置于其间进行一期缝合关闭。4毫米的阴茎尿道皮肤瘘也进行了一期缝合，并在一次手术中用睾丸鞘膜瓣覆盖。手术已过去6个月，患者完全能自主控制大小便，排尿良好，无尿液或粪便渗漏。
