In boys, this is a very rare anomaly. Aleem et al.  described a case with a perineal and a penoscrotal fistula, and Prasad (1970, personal communication) described a case with a rectovesical fistula and a patent stenotic anus. Rintala and Jarvinen  described five cases, two had rectovesical and anoperineal fistulas, two had anoperineal and urethral fistulas, and one had a fistula between the midurethra and a scrotal ec-topic anal opening. Wakhlu et al.  had four cases; three had two openings on the perineum and one had a urethral and a perineal opening with prune-belly syndrome. We have seen four cases; one had a rec-toprostatic urethral fistula and a rectoperineal fistula, one had rectobulbar urethral fistula and anal canal stenosis, and two had rectobulbar urethral fistula, narrow urethra, and anorectal stenosis (Fig. 15.9).
In girls, this condition is equally rare. Rintala et al.  reported two cases, one with a vulvar and a high vaginal fistula and the other with a perineal and a low vaginal fistula. Wakhlu et al.  also reported two cases, both had an anterior ectopic opening and a vestibular fistula. Bianchini et al.  reported a case with a very large rectovaginal fistula and anal canal stenosis. We have seen five cases; two had a vestibular and
a perineal fistula, two had a vaginal and a perineal fistula, and one had a vaginal and a vestibular fistula (Fig. 15.10). These can all be included in the Kricken-beck classification as variants of H-fistula.
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