INTRAOPERATIVE DAMAGE TO THE MALE URETHRA AND PELVIC VISCERAL MOTOR NERVES DURING POSTERIOR SAGITTAL ANORECTOPLASTY

The use of the sagittal surgical approach to the rectum and urinary fi stula in male patients with anorectal agenesis is addressed. Iatrogeni c damage to the urethra (1 in 60 cases) and pelvic plexus (2 in 60 cas es) occurred when the operator had difficulty identifying the rectum i ntraoperatively and where inappropriate midline dissection was done. T he importance of an adequate preoperative contrast rectogram and the i ntraoperative identification of the rectum with the aid of a catheter is emphasized. Perirectal blunt dissection is discouraged, the need fo r deep lateral directed tissue retraction is avoided by applying direc t traction onto the freed rectum, and a long and wide portion of recta l wall is left in the midline on the urethra and bladder neck. The ana tomy of the autonomic pelvic plexus at risk in the normal and congenit ally abnormal case is described.