Preoperative RGU–Fistulogram–guided Ksharsutra Therapy in Anterior Anal Fistula: A Case Report

Abstract

Anterior perianal fistulas are diagnostically challenging due to their close proximity to the urethra and genital tissues. Managing such a condition without prior precise diagnosis and care may result in unintended urethral trauma. This case of a complex anterior anal fistula is uncommon and has been documented very rarely in the past. We present the case of a 36-year-old male with a history of recurrent abscesses at the base of the scrotum. To rule out suspected urethral communication, combined retrograde urethrography and fistulography were performed, showing the tract in close proximity to the urethra. The patient was successfully treated with the Interception of Fistulous Tract with Application of Ksharsutra technique, with complete healing, preserved continence, and no recurrence at 6 months. This case highlights that combined retrograde urethrogram and fistulography can be a cost-effective, reliable method for preoperative planning in similar challenging anterior fistulas, reducing the risk of urethral injury.