Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
J Urol. 2012 Mar;187(3):1024-31. doi: 10.1016/j.juro.2011.10.162. Epub 2012 Jan 20.
Surgical management of the high urogenital sinus remains challenging. The anterior sagittal transrectal approach provides optimal exposure, facilitates vaginal dissection and separation from the urethra, and allows reconstruction of the bladder neck musculature. In this study we report our initial experience with this technique.
We performed a retrospective review of a 6-year multi-institutional experience treating patients with a urogenital sinus anomaly using the anterior sagittal transrectal approach without preoperative colostomy or prolonged postoperative fasting. Variables analyzed included patient age, associated malformations, the need for additional procedures and surgical outcomes.
A total of 23 children with a mean age of 2.3 years (range 3 months to 17 years) who underwent surgery between 2003 and 2010 were included in the study. Mean followup was 3.4 years (range 14 months to 7 years). All children had a high urogenital sinus with (16) or without (7) congenital adrenal hyperplasia. There were 3 isolated cases treated with additional procedures. Only 1 anterior sagittal transrectal approach related complication was encountered when a perineal infection developed in a child and required temporary diverting colostomy without compromising the repair. There were no postoperative urethrovaginal fistulas. All toilet trained patients were continent for feces and most were voiding normally per urethra (21), except for 2 with associated urological malformations. There were 15 patients who underwent followup examination under anesthesia, and demonstrated separate urethral and vaginal openings.
The anterior sagittal transrectal approach provides excellent exposure for the management of a high urogenital sinus, facilitating the separation of urogenital structures. Good outcomes in terms of urinary/fecal continence as well as the absence of urethrovaginal fistulas were achieved in the majority of cases, supporting its consideration for the surgical management of this congenital abnormality.
高尿生殖窦的外科处理仍然具有挑战性。前矢状经直肠入路提供了最佳的暴露，有利于阴道的解剖和与尿道的分离，并允许膀胱颈部肌肉的重建。在本研究中，我们报告了我们使用这种技术的初步经验。
我们对 2003 年至 2010 年间采用前矢状经直肠入路治疗尿生殖窦畸形患者的 6 年多机构经验进行了回顾性分析，术前无需行结肠造口术或长时间术后禁食。分析的变量包括患者年龄、伴发畸形、是否需要额外的手术和手术结果。
共有 23 名平均年龄为 2.3 岁（3 个月至 17 岁）的儿童在 2003 年至 2010 年间接受了手术。平均随访 3.4 年（14 个月至 7 年）。所有儿童均有高尿生殖窦，其中（16 例）或无（7 例）先天性肾上腺增生。有 3 例孤立病例需行额外手术。仅 1 例前矢状经直肠入路相关并发症发生，1 例患儿出现会阴感染，需行暂时性转流性结肠造口术，但不影响修复。无术后尿道阴道瘘。所有经如厕训练的患者均可控制粪便，大多数可正常经尿道排尿（21 例），除 2 例伴有泌尿道畸形。有 15 名患者在麻醉下进行了随访检查，显示出单独的尿道和阴道开口。
前矢状经直肠入路为高尿生殖窦的处理提供了极好的暴露，有利于尿生殖结构的分离。大多数情况下，在尿便控制方面取得了良好的结果，并且没有尿道阴道瘘，支持将其用于这种先天性异常的手术治疗。
