Gynecologic anatomic abnormalities following anorectal malformations repair

Vilanova-Sánchez, Alejandra; Reck, Carlos A.; McCracken, Kate; Lane, Victoria A.; Gasior, Alessandra C.; Wood, Richard J.; Levitt, Marc A.; Hewitt, Geri

doi:10.1016/j.jpedsurg.2017.07.012

Cited by 23 publications

(21 citation statements)

References 16 publications

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“…Children born with ARM undergo surgical reconstruction through posterior sagittal anorectal plasty (PSARP) [3]. As a result of the nature of ARM, possible concomitant malformations of the spine, urinary-and genital tract (and sometimes because of surgical damage), functional sequelae, such as faecal incontinence and impaired urinary tract-and sexual function, may remain throughout life [4][5][6][7]. Depression and other psychological disorders also seem to be frequent among adults born with ARM [4,8].…”

Section: Introductionmentioning

confidence: 99%

Key components of successful transition for adolescents born with anorectal malformations–a Nordic focus group study

Tofft

Hoel

Håkansson

et al. 2020

International Journal of Adolescent Medicine and Health

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ObjectivesTransitional care for adolescents with congenital malformations, such as anorectal malformations (ARM), is described sparsely in the literature and referred to as being inadequate. In order to organize future successful healthcare structures, knowledge of patient-reported important aspects of transition is required. The aim of the study was therefore to explore the needs and expectations of transitional- and adult healthcare among adolescents and adults born with ARM.MethodsTwo tertiary paediatric surgical centres, in collaboration with two tertiary pelvic floor centres, in Sweden and Norway, conducted a qualitative study, involving adolescents and adults born with ARM in focus group discussions regarding transitional care. Discussions were analyzed by qualitative content analysis. Ethical approval was obtained.ResultsSixteen participants (10 women) with a median age of 24 (19–47) years, born with mixed subtypes of ARM were included in gender-divided focus groups. Participants emphasized a need for improved knowledge of ARM, both among patients and adult care providers. Participants identified a need for support with coping strategies regarding challenging social- and intimate situations due to impaired bowel function. Participants pin-pointed well-functioning communication between the patient and the paediatric- and adult care providers as a key factor for a successful transitional process. Further, participants emphasized the importance of easy access to specialized adult healthcare when needed, suggested to be facilitated by appointed patient navigators.ConclusionAdolescents and adults born with ARM identify improved knowledge of ARM, well-functioning communication and easy access to specialized adult care as key components of a successful transition.

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Section: Introductionmentioning

confidence: 99%

Key components of successful transition for adolescents born with anorectal malformations–a Nordic focus group study

Tofft

Hoel

Håkansson

et al. 2020

International Journal of Adolescent Medicine and Health

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“…In this patient population, 4 patients were noted to have adhesive disease that required modification of the standard surgical technique to avoid injury to bladder and/or bowel. 11,17,19,40,41 This modification of a standard surgical cesarean section has also been described in other complex pelvic anomalies such as bladder exstrophy. 41 In 1 case, a transvesical cesarean section was performed because of multiple adhesions and abnormal position of the bladder.…”

Section: Pelvic Adhesionsmentioning

confidence: 95%

“…We previously reported a high incidence of reoperation in 28 girls (2 with cloacal malformation) with previously repaired ARMs. 19 The most common indications for reoperation were an abnormal perineal body and introital stenosis. In reproductive-aged women, an abnormal or reconstructed perineal body might lead to an increased rate of third-and fourth-degree perineal lacerations during vaginal delivery, pelvic floor dysfunction, and dyspareunia.…”

Section: Perineal Body Scarring/vaginal Introital Stenosismentioning

confidence: 99%

“…In reproductive-aged women, an abnormal or reconstructed perineal body might lead to an increased rate of third-and fourth-degree perineal lacerations during vaginal delivery, pelvic floor dysfunction, and dyspareunia. 19 Particularly in patients with adequate fecal continence, avoiding obstetrical anal sphincter injuries is paramount. An abnormal perineal body might affect recommended mode of delivery (favoring cesarean delivery) and obstetrical outcomes (increased risk of third-and fourth-degree lacerations) in patients with complex anorectal cloacal malformations.…”

Section: Perineal Body Scarring/vaginal Introital Stenosismentioning

confidence: 99%

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Obstetrical Outcomes in Adult Patients Born with Complex Anorectal Malformations and Cloacal Anomalies: A Literature Review

Vilanova-Sánchez

McCracken

Halleran

et al. 2019

Journal of Pediatric and Adolescent Gynecology

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a b s t r a c tPatients born with complex anorectal malformations often have associated M€ ullerian anomalies, which might affect fertility and obstetrical outcomes. Other vertebral-anorectal-tracheoesophageal-renal-limb associations, such as renal or cardiac anomalies, could also affect pregnancy intention, fertility rates, and recommendations about mode of delivery or obstetrical outcomes. Associated conditions present at birth, like hydrocolpos, could also potentially affect fertility. Depending on the complexity of the anomaly, primary reconstruction might include vaginoplasty, vaginal interposition, perineal body reconstruction, and extensive pelvic dissection. After the initial reconstruction, patients might have multiple additional surgeries for stoma reversal, bladder augmentation, and creation of conduits, all with potential for pelvic adhesions. Pregnancy intention, fertility rates, mode of delivery, and obstetrical outcomes data are limited in this patient population, making it challenging to counsel patients and their families. We sought to evaluate all available literature in an attempt to better counsel families. A PubMed literature search was undertaken to review this topic. Search terms of "cloaca," "anorectal malformation," "pregnancy," "cloacal exstrophy," "vaginal delivery," and "cesarean section" were used and citation lists from all identified articles were checked to ensure that all possible articles were included in the review. We also outline comorbidities from the fetal period to adulthood that might affect reproductive health. Of the articles on anorectal and cloacal anomalies, 13 reports were identified that covered obstetrical outcomes. They were in patients with previous anorectal malformation, cloaca, and cloacal exstrophy repair. Twenty-four pregnancies were reported in 16 patients. Two ectopic pregnancies, 5 spontaneous miscarriages, 1 triplet pregnancy, and 16 singleton pregnancies were reported with a total of 19 live births. Regarding the method of conception, 15/18 pregnancies occurred spontaneously and 3/18 were via assisted reproductive technology with in vitro fertilization. There were 19 live births, of which at least 8 were preterm. M€ ullerian anatomy was reported in 8 of 13 articles. Only 2 patients underwent vaginal delivery (1 patient with repaired cloaca malformation had an operative vaginal delivery and 1 patient with repaired imperforate anus with rectovaginal fistula had a normal spontaneous vaginal delivery). The remaining patients all underwent a cesarean section. There were no reported cases of maternal mortality, and maternal morbidity was limited to recurrent urinary tract infections and worsening chronic kidney disease. There is a paucity of information regarding obstetrical outcomes in adult anorectal and cloaca patients. However, patients with previous cloacal repairs have achieved pregnancy spontaneously, as well as with in vitro fertilization. Patients with repaired cloacal malformations are at increased risk of preterm birth and cesarean delivery. Most p...

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“…Cystoscopy is conducted to assess for defect in urethra and bladder or ectopic ureters. Vaginoscopy is used to evaluate remnants of rectovaginal or rectovestibular fistulae, residual vaginal longitudinal septum, evaluation of vaginal introitus, assessment for stricture and requirement for introitoplasty/dilations and evaluation of cervix or cervices [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Transfistula anorectoplasty on adult female anorectal malformation: A rare case report

Priyatini

Roziana

2020

International Journal of Surgery Case Reports

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Gynecologic anatomic abnormalities following anorectal malformations repair

Cited by 23 publications

References 16 publications

Key components of successful transition for adolescents born with anorectal malformations–a Nordic focus group study

Key components of successful transition for adolescents born with anorectal malformations–a Nordic focus group study

Obstetrical Outcomes in Adult Patients Born with Complex Anorectal Malformations and Cloacal Anomalies: A Literature Review

Transfistula anorectoplasty on adult female anorectal malformation: A rare case report

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