Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
J Pediatr Surg. 2010 Feb;45(2):397-400. doi: 10.1016/j.jpedsurg.2009.10.085.
We report a novel technique to measure the length of the rectourethral fistula (RUF) in male patients with high-/intermediate-type imperforate anus during laparoscopically assisted anorectal pull-through (LAARP) to prevent incomplete excision.
During LAARP for RUF in 5 male patients (mean age, 4.6 months; prostatic in 3, bulbar in 2), the RUF was dissected carefully close to the urethra and opened; and a fine catheter with 10-mm calibrations was inserted by the laparoscopic surgeon until it was seen to emerge at or near the verumontanum by another surgeon performing cystoscopy. The laparoscopic surgeon then measured the distance from the point where dissection was ceased at the rectal end to the urethral orifice. The RUF was dissected free from the prostate for exactly this length, tied, and excised; and colon pull-through was performed to finish LAARP.
Rectourethral fistulae ranged from 5 to 15 mm and were much longer than expected. All dissections were uncomplicated without any injury to the urethra, and postoperative courses were unremarkable. At mean follow-up of 11 months, urination is normal in all without evidence of residual fistula.
Knowing the exact length of the RUF facilitates safe and complete excision in an otherwise blind situation.
我们报告了一种在腹腔镜辅助直肠肛门拖出术（LAARP）中测量高位/中间型肛门闭锁男性患者直肠尿道瘘（RUF）长度的新技术，以防止不完全切除。
在 5 名男性患者（平均年龄 4.6 个月；前列腺 3 例，球部 2 例）的 LAARP 中，仔细解剖靠近尿道并打开 RUF；由腹腔镜外科医生插入带有 10mm 校准的细导管，直到另一位进行膀胱镜检查的外科医生看到它从精阜处或附近穿出。然后，腹腔镜外科医生测量从直肠末端停止解剖到尿道口的距离。RUF 从前列腺游离出来的长度正好为这个距离，然后结扎并切除；然后进行结肠拖出术完成 LAARP。
直肠尿道瘘的长度为 5 至 15 毫米，比预期的要长得多。所有的解剖都没有任何并发症，没有损伤尿道，术后过程也没有异常。在平均 11 个月的随访中，所有患者的排尿均正常，没有瘘管残留的证据。
了解 RUF 的准确长度有助于在盲视情况下安全、完全切除。
