Fetal lower urinary tract obstruction is a rare condition commonly associated with significant perinatal morbidity and mortality, particularly when detected in the second trimester. The concurrent presentation of a recto-urethral fistula with membranous urethral atresia and sacrococcygeal teratoma has not been reported. We describe a case of extrinsic fetal lower urinary tract obstruction related to a recto-urethral fistula, diagnosed at 33 weeks gestation and managed by serial vesicocentesis until 38 weeks. This case, notable for its absence of hypoplasia despite late diagnosis, resulted in a term delivery of a male infant. After delivery, pediatric surgeons performed an abdominal perineal resection of the tumor. Fetal vesicocentesis remains a viable management option for patients without access to intrauterine surgical interventions.

Fetal lower urinary tract obstruction is a rare condition commonly associated with significant perinatal morbidity and mortality, particularly when detected in the second trimester. The concurrent presentation of a recto-urethral fistula with membranous urethral atresia and sacrococcygeal teratoma has not been reported. We describe a case of extrinsic fetal lower urinary tract obstruction related to a recto-urethral fistula, diagnosed at 33 weeks gestation and managed by serial vesicocentesis until 38 weeks. This case, notable for its absence of hypoplasia despite late diagnosis, resulted in a term delivery of a male infant. After delivery, pediatric surgeons performed an abdominal perineal resection of the tumor. Fetal vesicocentesis remains a viable management option for patients without access to intrauterine surgical interventions.