A Neonatal Case of Lower Urinary Tract Obstruction and Imperforate Anus: Urethral Decompression Due to Rectourinary Fistula

Lower urinary tract obstruction (LUTO) is a rare fetal condition associated with significant perinatal morbidity and mortality. Herein, we report a neonatal case of LUTO with anal atresia complicated by anhydramnios and pulmonary hypoplasia. After treatment for severe postnatal respiratory distress, the neonate underwent vesicostomy and colostomy. Postoperatively, respiratory status and renal function improved. This case highlights a unique feature where a large rectovesical fistula channeled fetal urine into the colon, which minimized obstructive damage to the urinary tract and preserved renal morphology. Fetal colonic dilatation and numerous enteroliths indicate urine influx into the intestinal tract. Our case suggests the importance of recognizing such exceptions in complete LUTO to predict postnatal outcomes diagnosed in utero.