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.
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.
Authors: Jeong Ho Eom; Jai Hoon Yoon; Seok Won Lee; Hyo Sun Kim; Tae Young Park; Chang Seok Bang; Gwang Ho Baik; Dong Joon Kim Journal: Clin Endosc Date: 2016-03-15