Posterior sagittal anorectoplasty for the surgical treatment of rectourethral fistula

Approximately seventy percent of all male patients born with an anorectal malformation suffer from a rectourethral fistula. This is an abnormal communication between rectum and urethra. The goal of the surgeon is to separate the rectum from the urinary tract, to close the urethral fistula, to pull down the rectum, and to place it precisely within the limits of the sphincter mechanism. The procedure we demonstrate here is called a Posterior Sagittal Anorectoplasty (PSARP).

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Posterior   sagittal   anorectoplasty   for   the   surgical   treatment   of   rectourethral   fistula

Authors
Abstract
Approximately seventy percent of all male patients born with an anorectal malformation suffer from a rectourethral fistula. This is an abnormal communication between rectum and urethra. The goal of the surgeon is to separate the rectum from the urinary tract, to close the urethral fistula, to pull down the rectum, and to place it precisely within the limits of the sphincter mechanism. The procedure we demonstrate here is called a Posterior Sagittal Anorectoplasty (PSARP).
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Duration
14'19''
Publication
2011-10
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en
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en
E-publication
WeBSurg.com, Oct 2011;11(10).
URL: http://www.websurg.com/doi-vd01en3438.htm

Posterior   sagittal   anorectoplasty   for   the   surgical   treatment   of   rectourethral   fistula

6. Separating rectum from urethra 04'39''
The next surgical step represents the most delicate part of the operation, which is the separation of the rectum from the urethra. For this, multiple 6/0 silk sutures are placed, one or two millimeters apart, positioned in a semi-circumferential fashion, surrounding the upper part of the fistula. These stitches will prove to be extremely useful, because they will represent a very good handle to apply uniform traction on the anterior rectal wall to facilitate its separation from the posterior urethra. The stitches should only take the rectal mucosa. This diagram shows the cutting of the rectal mucosa in between the fistula and our stitches. And here we can see the same maneuver in our patient. No attempt should be made to continue the separation of rectum from the urethra at this point. A very helpful and valuable maneuver at this point is to expose the lateral wall of the rectum and dissect the rectum between the rectal fascia and the rectal wall. This is a very clear plane. The dissection of the rectum should only be performed while staying as close as possible to the rectal wall but without injuring the wall itself. Having established the lateral plane of dissection, we can now come back to the separation of rectum from urethra, having as a reference the lateral wall of the rectum. Same dissection is initiated in the opposite side. Again, in this side, once the lateral plane has been clearly established, we can come back to the separation of rectum and urethra. The dissection proceeds slowly and meticulously, checking the thickness of the rectal wall as we progress with the dissection. The pre-established lateral plane of dissection is always a point of reference as shown here. The dissection continues until the rectum has been completely separated from the urethra, as shown in this diagram. This is the fistula, and this, the rectum completely separated. The rectum has been separated completely from the urinary tract in our patient.