2-Month-Old Male Patient with Stool and Urine Coming from Penoscrotal Hypospadias

Joe DiMaggio Children's Hospital, Hollywood, FL

Case Summary

  • 2-month-old male presents for evaluation. He was born at 37 weeks gestation.
  • He was noted to have urine and stool coming out from a penoscrotal hypospadias.
  • Prenatally, he was diagnosed with solitary right kidney.
  • He also had VSD, hemivertebrae, hydronephrosis of the right kidney with megaureter and agenesis of the left kidney.
  • Colostomy and vesicostomy were placed on day 3 of life.
  • Distal colostogram showed a fistula.
  • Cystoscopy was performed.
  • Insertion of the distal ureter was identified immediately below the bladder neck.
  • Electrostimulator was used to evaluate the anus, which had good contraction. The distal rectal length was normal.


  • This is a complex anomaly.
  • The anus must be preserved in order to give the patient the best prognosis for bowel control.
  • Posterior sagittal trans-anorectal would be an ideal approach to repairing this type of malformation. This would create a “T” anastomosis.
  • Having solitary kidney, reflux and the ureter below the bladder neck is concerns for future urological function. A reimplant may be indicated. The vesicostomy should remain in place. The kidney function should be followed closely.
  • Colostomy should be performed on this type of complex malformation.
  • Laparoscopy is a useful technique for bladder neck fistulas.

Patient Case Discussion

Loading video...


Rate This Presentation: 
Your rating: None
No votes yet