Portal de Periódicos da CAPES

Surgical Treatment of High Urogenital Sinuses Using the Anterior Sagittal Transrectal Approach: A Useful Strategy to Optimize Exposure and Outcomes

2012; Lippincott Williams & Wilkins; Volume: 187; Issue: 3 Linguagem: Inglês

10.1016/j.juro.2011.10.162

1527-3792

João L. Pippi Salle, Armando J. Lorenzo, Lisieux Eyer de Jesus, Bruno Leslie, Abdulnasser AlSaid, Francisco Nicanor Macedo, Venkata R. Jayanthi, Roberto De Castro,

Pediatric Hepatobiliary Diseases and Treatments

No AccessJournal of UrologyPediatric Urology1 Mar 2012Surgical Treatment of High Urogenital Sinuses Using the Anterior Sagittal Transrectal Approach: A Useful Strategy to Optimize Exposure and Outcomes João L. Pippi Salle, Armando J. Lorenzo, Lisieux E. Jesus, Bruno Leslie, Abdulnasser AlSaid, Francisco Nicanor Macedo, Venkata R. Jayanthi, and Roberto de Castro João L. Pippi SalleJoão L. Pippi Salle Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada More articles by this author , Armando J. LorenzoArmando J. Lorenzo Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada More articles by this author , Lisieux E. JesusLisieux E. Jesus Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada More articles by this author , Bruno LeslieBruno Leslie Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada More articles by this author , Abdulnasser AlSaidAbdulnasser AlSaid Ibnsina Hospital, Pediatric Surgery, Sulaibikat, Kuwait More articles by this author , Francisco Nicanor MacedoFrancisco Nicanor Macedo Hospital Jesus, Division of Pediatric Surgery, Rio de Janeiro, Brazil More articles by this author , Venkata R. JayanthiVenkata R. Jayanthi Pediatric Urology, Nationwide Children Hospital, Columbus, Ohio More articles by this author , and Roberto de CastroRoberto de Castro Pediatric Surgery, Hospital CdC Petrucciani, Lecce, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.10.162AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Surgical management of the high urogenital sinus remains challenging. The anterior sagittal transrectal approach provides optimal exposure, facilitates vaginal dissection and separation from the urethra, and allows reconstruction of the bladder neck musculature. In this study we report our initial experience with this technique. Materials and Methods: We performed a retrospective review of a 6-year multi-institutional experience treating patients with a urogenital sinus anomaly using the anterior sagittal transrectal approach without preoperative colostomy or prolonged postoperative fasting. Variables analyzed included patient age, associated malformations, the need for additional procedures and surgical outcomes. Results: A total of 23 children with a mean age of 2.3 years (range 3 months to 17 years) who underwent surgery between 2003 and 2010 were included in the study. Mean followup was 3.4 years (range 14 months to 7 years). All children had a high urogenital sinus with (16) or without (7) congenital adrenal hyperplasia. There were 3 isolated cases treated with additional procedures. Only 1 anterior sagittal transrectal approach related complication was encountered when a perineal infection developed in a child and required temporary diverting colostomy without compromising the repair. There were no postoperative urethrovaginal fistulas. All toilet trained patients were continent for feces and most were voiding normally per urethra (21), except for 2 with associated urological malformations. There were 15 patients who underwent followup examination under anesthesia, and demonstrated separate urethral and vaginal openings. Conclusions: The anterior sagittal transrectal approach provides excellent exposure for the management of a high urogenital sinus, facilitating the separation of urogenital structures. Good outcomes in terms of urinary/fecal continence as well as the absence of urethrovaginal fistulas were achieved in the majority of cases, supporting its consideration for the surgical management of this congenital abnormality. References 1 : Total urogenital sinus mobilization: a modified perineal approach for feminizing genitoplasty and urogenital sinus repair. J Urol2001; 165: 2347. Google Scholar 2 : Prospective evaluation of feminizing genitoplasty using partial urogenital sinus mobilization for congenital adrenal hyperplasia. J Urol2006; 176: 2199. Link, Google Scholar 3 : Adrenogenital syndrome: the anatomy of the anomaly and its repair: Some new concepts. J Pediatr Surg1969; 4: 49. Google Scholar 4 : Total urogenital mobilization–an easier way to repair cloacas. J Pediatr Surg1997; 32: 263. Google Scholar 5 : Transanorectal approach for the treatment of urogenital sinus: preliminary report. J Pediatr Surg1992; 27: 681. Google Scholar 6 : Anterior sagittal transanorectal approach to the urogenital sinus in adrenogenital syndrome: preliminary report. J Pediatr Surg1997; 32: 714. Google Scholar 7 : Objective cosmetic and anatomical outcomes at adolescence of feminising surgery for ambiguous genitalia done in childhood. Lancet2001; 358: 124. Google Scholar 8 : Passerini-Glazel feminizing genitoplasty: modifications in 17 years of experience with 82 cases. Eur Urol2007; 52: 1638. Google Scholar 9 : A new classification for genital ambiguity and urogenital sinus anomalies. BJU Int2005; 95: 638. Google Scholar 10 : Subject of controversy: total urogenital mobilization. Dialogues Pediatr Urol2000; . vol. 23, No. 4. Google Scholar 11 : A dissenting viewpoint concerning total urogenital mobilization. Dialogues Pediatr Urol2000; . vol. 23, No. 4. Google Scholar 12 : Endometriosis in association with müllerian anomalies. Gynecol Obstet Invest1995; 40: 261. Google Scholar 13 : The correction of congenital abnormalities of the vagina and perineum. J Pediatr Surg1980; 15: 751. Google Scholar 14 : The posterior sagittal pararectal approach to posterior urethral anomalies. J Urol1994; 151: 1365. Link, Google Scholar 15 : Does the posterior sagittal approach with perirectal dissection impair fecal continence in a normal rectum?. J Pediatr Surg1996; 31: 1349. Google Scholar 16 : Continence after posterior sagittal anorectoplasty. J Pediatr Surg1992; 27: 413. Google Scholar 17 : The anterior sagittal transanorectal approach: a modified approach to 1-stage clitoral vaginoplasty in severely masculinized female pseudohermaphrodites–preliminary results. J Urol1997; 157: 330. Link, Google Scholar 18 : The neonatal management and surgical correction of urinary hydrometrocolpos caused by a persistent urogenital sinus. BJU Int1999; 84: 1063. Google Scholar 19 : Reconstruction of the high urogenital sinus: early perineal prone approach without division of the rectum. J Urol1997; 158: 1293. Link, Google Scholar © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 3March 2012Page: 1024-1031 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordspatient positioningchildurogenital abnormalitiesMetricsAuthor Information João L. Pippi Salle Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada More articles by this author Armando J. Lorenzo Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada More articles by this author Lisieux E. Jesus Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada More articles by this author Bruno Leslie Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada More articles by this author Abdulnasser AlSaid Ibnsina Hospital, Pediatric Surgery, Sulaibikat, Kuwait More articles by this author Francisco Nicanor Macedo Hospital Jesus, Division of Pediatric Surgery, Rio de Janeiro, Brazil More articles by this author Venkata R. Jayanthi Pediatric Urology, Nationwide Children Hospital, Columbus, Ohio More articles by this author Roberto de Castro Pediatric Surgery, Hospital CdC Petrucciani, Lecce, Italy More articles by this author Expand All Advertisement PDF downloadLoading ...