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

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.

Takeaways

• 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.