Mohamed Taha Ahmed is a male child suffering from...

Mohamed Taha Ahmed is a male child suffering from congenital anorectal malformation with caudal regression syndrome and urogenital anomalies in the form of midpenile hypospadias, Rt undescended testicle, neurogenic bladder and bilateral refluxing ureters. The child was operated on Mars 2009 by surgical team in specialised children hospital of cairo university for his anorectal malformation and Pena operation was attempted but failed thus abdominoperineal pull through and traseverse colostomy with appendicectomy and Meckel’s diverticulectomy was performed. colostomy was closed 6 months later. The urologic team of the same hospital then took over by 2010. Cystourethroscopy for obstructive symptoms and repeated febrile UTI revealed stricture bulbar urethra (site of previous recto vesical fistula) dilatation was done and vesicostomy was performed to control infections. Orchiopexy of the Rt testis was performed by 2011. By 2012 closure of vesicostomy after confirmation of patency of the urethra by cystourethroscopy was performed. Urodyamic studies revealed hypotonic bladder and residual urine thus CIC regimen was advised but was difficult to be toleratedby the child and the parents. During the follow up and control of his repeated infections the child developed bilateral radiolucent stones, thus alkalinisation of urine was started to try medical dissolution of the stones. Bilateral DJ fixation was performed to relieve the obstruction during trial of dissolution of the stones by alkalinisation by 2013. By 2014 PCNL for remaval of the lt kidny stone and URS of the rt side was succeful to clear the stones and another trial of CIC with anticholinergics and antibioprophylaxis was advised. Now the child has normal chemistry, no stones or obstruction and controlled repeatedUTI. The child does not tolerate well the CIC, thus he is incontinent to urine, also he does not tolerate repeated enemas thus he is incontinent to stools. dilated refluxing non obstructed urinary system.