OPERATIVE TRAUMA TO THE GENITOURINARY TRACT IN THE TREATMENT OF ANORECTAL-MALFORMATIONS - 15 YEARS EXPERIENCE

Objectives. To determine the incidence of urologic trauma during surgi cal correction of anorectal malformations (ARM). Methods. The records of 228 children with ARM were retrospectively reviewed. Results. Opera tive trauma to the genitourinary tract was seen in 12 patients, all ma le. Of 133 patients with a high ARM, 92 underwent an abdominoperineal pull-through and 41 underwent a posterior sagittal anorectoplasty (PSA RP); the incidence of urologic trauma was 12% and 0%, respectively. In the subgroup of male infants with a high ARM (99 patients), the incid ence of genitourinary trauma was 11%; in those with a low anomaly, the incidence was 1 of 43 (2%). There were 3 urethral tears, 4 urethral s trictures, 5 urethral diverticula, 2 vas deferens injuries, and 1 uret eric injury. Nine of the 12 patients do not have any long-term sequela e resulting from the injuries; however, 2 are now infertile and 1 has urinary incontinence. Four patients are additionally compromised becau se of an absent or nonfunctioning kidney on one side. Conclusions. In children with ARM, those under-going a conventional pull-through repai r are more likely to have a genitourinary injury than those undergoing the PSARP, and boys with high ARM are at greatest risk.