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Case Reports
. 2006 Jan;88(1):26.
doi: 10.1308/147870806x83242.

Diagnosis and conservative treatment of tubercular rectoprostatic fistula

Santosh Kumar  1 , Nitin S Kekre, Ganesh Gopalakrishnan
Affiliations
Case Reports

Diagnosis and conservative treatment of tubercular rectoprostatic fistula

Santosh Kumar et al. Ann R Coll Surg Engl. 2006 Jan.

Abstract

Objective: To present our experience with three cases of rectoprostatic fistula with special emphasis on diagnosis and conservative management.

Patients and methods: Three middle-aged men presented to us differently. All had spontaneous rectoprostatic fistulas. Biopsy showed tuberculosis though three consecutive urine samples for acid-fast bacilli were negative. None of the patients were immunocompromised. Their upper tracts were normal and all had a past history of pulmonary tuberculosis. They were started on antitubercular drugs and urinary diversion with or without faecal diversion.

Results: All fistulae healed completely within 6 weeks of starting antitubercular treatment. One patient healed with bladder neck stenosis that required bladder neck incision. Voiding was normal on 1-year follow-up.

Conclusion: Spontaneous tubercular rectoprostatic fistulae are rare. There should be a strong clinical suspicion in endemic areas. Prostatic biopsy proves the diagnosis. Conservative management with antitubercular drugs and urinary diversion with or without faecal diversion has a high success rate and should be the first line of treatment even if urine is negative for acid-fast bacilli.

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Figures

Figure 1
Figure 1
CT pelvis of case 1 showing extravasation of contrast from the prostatic urethra tracking posteriorly into the rectum.
Figure 2
Figure 2
Post-treatment MCU of case 2 showing residual focal pooling of contrast in prostatic cavity with a healed rectoprostatic fistula.
Figure 3
Figure 3
RGU of case 3 showing extravasation of contrast into the rectum.
Figure 4
Figure 4
Post-treatment MCU of case 3 showing a healed rectoprostatic fistula and a small residual prostatic biopsy.
See this image and copyright information in PMC

References

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