Jammu Boy Amol Born Without Anal Opening & Recto Urethral Fistula cured by Dr Porwal DLPL operation

Amol Dhar during an interview with the editor and Dr Ashwin Porwal

() What kind of congenital anomaly the boy suffered and how he was treated for that soon after the birth?

He was born with Ano Rectal Malformation. He had imperforate anus , its a congenital anomaly, in which the anal opening is absent.Thus, the child doesn’t have any passage for defecation.
For which he underwent surgery immediately after his birth in 2 stages. First involved colostomy ( taking out part of colon from abdomen, thus making a way to pass motions through the stoma)

Stage 2
Involved colostomy reversal.
This was done after 2 years of his first surgery, after which he started passing motions through his anal canal.
The above surgeries were performed at his home town in Jammu.
() When did the problem regarding passing the surface of the stool and what was his age at this stage? What kind of complaints he had at this stage and how he was treated during this period?

As he was passing stools from the urine, he started getting sever urinary tract infection on regular intervals , for which his parents were taking him to local doctors who used to treat him for urine infection.

But every passing year , episodes of urine infection increased and got more severe, for which he was getting admitted in hospital.

When he was 17-18 years old during similar episode of urinary tract infection , one of the doctors from his hometown suspected that it can be a Recto Urethral Fistula which is causing recurrent urinary tract infection , and it got confirm with investigations like CT scan ,MRI and urine examination.

() How many hospitals he visited soon after that and what had been the doctors' advice to the boy during this period?

I was advised permanent Stoma for passage of stools ( A bag is placed on the abdomen through which stools are passed ) and Anus closed permanently.
We never wanted this as I couldn’t imagine my life this way. Hence we never accepted the surgery.
Later I was advised to get MRI done. Following which my consultation journey was gruesome. I first approached Urology at Chandigarh PGI who then referred me to Top Gastroenterologist. Unfortunately they couldn’t help me. I was helpless. I thought my prayers were answered when I went to meet Urologist Fortis Hospital, Mohali. But I was wrong. They transferred my case to Delhi AIIMS.
They too, couldn’t take up this challenging case. Finally I met Urologist of BLK Max super specialty hospital, Delhi. He gave me some hope by offering 20% success rate. I was scared & Disheartened. Finally me & my family returned to Jammu.

() When did he approach HHC for the treatment and what was the stage of his complaints/fistula during this time?

He got to know about Healing Hands Clinic through YouTube channel where he came across a 50 year old man rare surgery video who was passing gas through the urine and was cured by Dr Porwals DLPL surgery. He came to us in December 2021 with complaint of passing large quantity of stools from penis while urinating and recurrent urinary tract infection.
We diagnosed him as a case of Rare Adult complex recto urethral fistula.

() When did he first undergo surgery at HHC?

He got his first surgery done on 15th Dec 2021.
It took 5hrs and included multiple steps like cystoscopy, proctoscopy, endoanal imaging and finally followed by DLPL ( Distal Laser Proximal Ligation ) surgery. DLPL is especially devised for such such complex fistula cases , says Dr Porwal.

During Cystoscopy we realised there were two big 1*1 cm defects in the urethra
Making his surgery even more complicated says , Urosurgeon Dr Himesh Gandhi.

() What were the challenges in treating the boy and how did you address them ?
The 1st biggest challenge was to treat the Fistula through the Natural Trans Anal Route without performing Stoma ( Diversion of stool through the abdomen )
The 2nd challenge was psychological support to the patient and his family
It was very clear from the beginning that treating this type of complex urethral fistula is going to be a long procedure. We had multiple round of counselling with the patient and his family to keep the moral high,to have patience , and to keep him positive through out this period.
The 3rd challenge was finances. The total treatment lasted for almost 6 Months with repeated hospitalisation and surgeries. The cost of such treatment goes to 35-40L in private hospital. But 90% of his cost was sponsored through Healing Hands Foundation as wanted to make sure that no stone is unturned in curing him from this rare medical condition.
() How rare is his condition?

There are only 8 cases of Recto Urethral Penile fistula ( Frank passage of stools from penis ) reported till date in the world ( all outside India )
And all our in the paediatric age group.
There is not a single case about Adult Age Rectum - Penile fistula ( With frank stools from penis ) based on the literature search ,Says Surgeon Dr Ashwin Porwal at Healing Hands Clinic.

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