Intraoperative measurement of rectourethral fistula: prevention of incomplete excision in male patients with high-/intermediate-type imperforate anus

Comparison of anorectal angle and continence after Georgeson and Peña procedures for high/intermediate imperforate anus

“…The HIIA cases treated by PSARP were 2 males with rectovesical fistula, 8 males with rectobulbar urethral fistula, 1 male with anorectal agenesis without fistula, and 2 females with rectovestibular fistula. All HIIA surgeries (GPT or PSARP) were performed under the direct supervision of a single board-qualified pediatric surgeon (AY) with extensive experience in both techniques and equivalent success rates to published reports [1,[6][7][8][9][10]. Conventional techniques as described by Georgeson et al [1,6] were used to perform GPT.…”

“…The remaining 10 patients (1 case of rectoprostatic urethral fistula and 9 cases of rectobulbar urethral fistula) had PSARP because we experienced a complication secondary to residual fistula during GPT. However, since refining our GPT procedure by measuring the length of the distal fistula [9] before excising it, we have since restarted performing GPT.…”

Refining the intraoperative measurement of the distal intrapancreatic part of a choledochal cyst during laparoscopic repair allows near total excision

“…We attributed our lower incidence of postoperative complications to IE [11,12] and found a ureteroscope was best for IE because the IPCC could be observed at the same time as debris could be washed away because the flow of normal saline through a ureteroscope is constant. We adapted this concept for use during lapCC using an extra trocar inserted through a minimal incision to measure the exact length of the IPCC in the same way as we routinely measure the length of rectourethral fistulas intraoperatively during laparoscopic anorectoplasty for male imperforate anus [13]. Surprisingly, 10/16 cases had IPCC we considered problematic and required further dissection which we would have been unaware of if we had just relied on conventional dissection and experience to decide where to cease dissection.…”

Cystoscopic-assisted excision of rectourethral fistulas in males with anorectal malformations

“…A fine ureteral catheter was then inserted into the tract to label the rectourethral fistula. With the help of cystoscopy, the length of the rectourethral fistula could be calculated and complete excision of fistula could be guaranteed [5].…”

“…Many methods have been used to identify rectourethral fistulas, including preoperative augmented pressure colostogram [3] and intraoperative endoscopy [4][5][6]. In this study, we performed cystoscopy and labeled the rectourethral fistula with a ureteral catheter before posterior sagittal anorectoplasty (PSARP).…”