ANTERIOR SAGITTAE TRANSANORECTAL APPROACH TO THE POSTERIOR URETHRA INTHE PEDIATRIC AGE GROUP

Purpose: Surgical access to the posterior urethra is often difficult a nd several surgical solutions have been proposed. We suggest an anteri or sagittal transanorectal approach based on splitting the anterior re ctal wall only. This alternative technique provides excellent exposure to the retrourethral region, permitting simple and safe surgery. Mate rials and Methods: Between 1994 and 1996 we performed surgery via the anterior sagittal transanorectal approach in 8 patients with a mean ag e of 9.06 years. Patients included 1 girl with a posttraumatic urethro vaginal fistula, 3 with intersex disorders (2 with mixed gonadal dysge nesis raised as boys and 1 with male dysgenetic pseudohermaphroditism with an enlarged urtricle) and 4 boys (1 with penile agenesis raised a s girl, 2 with urethral duplication and 1 with prostatic rhabdomyosarc oma), The patient was placed in a knee-chest position. A midline sagit tal incision was made through the anterior anorectal wall only and dee pened through the perineal body to expose the posterior urethra and re trovesical space. After the pathological condition was corrected the a nterior rectal wall and perineal body were reconstructed. The operatio n was completed with protective colostomy. In our final patient with p rostatic rhabdomyosarcoma the anterior sagittal transanorectal approac h was used without colostomy. Anorectal manometry was done 6 months po stoperatively. Results: All patients were completely continent of stoo l and urine. Convalescence was unremarkable in all cases. Postoperativ e manometry in 7 patients revealed no differences from preoperative me asurements. Conclusions: This procedure should be considered a useful alternative to other techniques for various congenital and acquired pe lvic disorders.