LAUSR

rectoscrotal fistula, an extremely rare type of H-type ARM. De Vries and Friedland consider that the H-type fistula is a persistence of the cloacal duct of Reichel. Meanwhile, Stephens and Donnellan propose the two-part septum theory that provides for a spectrum of other similar deformities that may arise at higher or lower levels along the urethra to connect with the rectum or perineum. The development of H-type ARM is complex and its embryology has not been completely elucidated; hence, the management of H-type ARM should be well considered. In H-type ARM, some cases are associated with genitourinary anomalies, such as urethral hypoplasia and urethral stenosis. The closure of the rectourethral fistula without making alternative arrangements, thereby meaning that pressure is applied on the closed site, increases the risk of recanalization of the fistula. Therefore, it is necessary to confirm the presence of urinary anomalies before anorectoplasty. Considering the aforementioned points, we performed urethroscopy and colonoscopy before anorectoplasty. The present patient had no genitourinary anomalies and we did not encounter a recanalization of the fistula postoperatively. In the present case, urethrography showed that the common wall between the anterior wall of the rectum and the posterior wall of the urethra was long, and the urethroscopy indicated that the openings of the fistulae were very close together. Thus, it is essential to confirm the positional relation between the rectum and urethra before anorectoplasty. The strip-shaped incision of the rectum and its reconstruction to avoid injury to the urethra was useful as an operative method for rectourethral fistulae with a long common wall.