WOFAPS 2025 8th World Congress of Pediatric Surgery

Rachida Lamiri, Nahla Kechiche, Nouha Boukhrissa, Salma Mani, Imed Krichene, Mongi Mekki, Lassaad Sahnoun

department of pediatric surgery , University Hospital of Monastir

Background:

Congenital anterior urethrocutaneous fistulas (CAUFs) are exceptionally rare urogenital anomalies that may be isolated or associated with conditions such as anorectal or penoscrotal malformations. Their rarity and potential association with other anomalies can complicate diagnosis and management. Reporting such cases helps expand current knowledge, guide surgical decision-making, and optimize outcomes.

Methods:

We report a series of four pediatric patients with CAUFs managed surgically in our institution. All patients underwent a comprehensive clinical assessment, including urinalysis, ultrasound, and voiding cystourethrogram, to evaluate the anatomy and rule out associated anomalies.

Results:

The patients, aged 18 months to 5 years, presented with ventral penile fistulas visible since birth. One case was isolated; the others were associated with glandular hypospadias, penoscrotal bifidity, or multiple fistulous tracts. In all cases, urinary flow was noted both through the external meatus and the fistulous opening(s). Surgical management was tailored to the anatomical presentation and included primary fistula repair using local tissue flaps, two-layer urethral closure, and, when needed, hypospadias correction. One patient experienced a postoperative recurrence requiring revision surgery, after which a favorable outcome was achieved. No other complications or recurrences were noted during follow-up, which ranged from 6 months to 3 years.

Conclusion:

CAUF is a rare congenital anomaly requiring careful evaluation to confirm diagnosis and identify associated abnormalities. Surgical correction remains the cornerstone of management, and when individualized appropriately, leads to excellent long-term outcomes. Early recognition and tailored intervention are essential to prevent complications and ensure normal urinary function and penile morphology.