ENDOSCOPIC MANAGEMENT OF INFECTED ENLARGED PROSTATIC UTRICLES AND REMNANTS OF RECTOURETHRAL FISTULA TRACTS OF HIGH IMPERFORATE ANUS

Purpose: Infected enlarged prostatic utricles and infected remnant fis tula tracts of high imperforate anus are usually managed by a suprapub ic, transtrigonal or posterior sagittal approach. We describe a minima lly invasive endoscopic approach to these entities. Materials and Meth ods: We treated 12 patients with infected enlarged prostatic utricles and 4 with infected remnant fistula tracts using endoscopic techniques . Specifically a resectoscope with a bulb electrode or a cystoscope wi th a Bugby electrode was used to fulgurate circumferentially the dilat ed utricle or remnant fistula. After fulguration a Councill catheter w as placed in the lesion for 3 to 5 days and urine was diverted via a s uprapubic tube for 2 to 3 weeks. Obliteration of the abnormality was v erified by a voiding cystourethrogram.Results: Using this technique me dian postoperative hospital stay was 2 days (range 0 to 7). The enlarg ed prostatic utricle or remnant fistula tract was completely obliterat ed in 87% of the cases (62% after 1 and 25% after 2 treatments). Of ou r patients 13% had a significant (greater than 50%) decrease in utricu lar cyst size although a urethral abnormality persisted. Postoperative morbidity was minimal. One patient (6%) had a fever for 3 days postop eratively and none has had a urethral structure during a median follow up of 2 years (range 3 months to 4 years). Conclusions: Although it is not a panacea, electrofulguration of an enlarged prostatic utricle an d/or remnant fistula of imperforate anus is a simple procedure that ha s a high rate of success, does not require prolonged hospitalization a nd is associated with minimal morbidity.