Surgical treatment of a congenital malformation of the anorectal area: rectourethral fistula in children
DOI:
https://doi.org/10.15574/PS.2024.4(85).8592Keywords:
anorectal malformation, rectourethral fistula, associated malformations, posterosagittal anorectoplasty, abdominoperineal anorectoplasty, children, boysAbstract
Rectourethral fistula (RUF) is a variant of congenital anorectal malformation (СARM) in boys, characterized by abnormal connection of atretic rectum with urethra.
Aim - to evaluate results of surgical treatment in boys with RUF, using a differentiated approach to diagnosis and treatment in isolated and associated forms.
Materials and methods. The study included 20 boys: 10 with rectoprostatic fistula and 10 with rectobulbar, representing 13.0% of all treated anorectal anomalies (n=154). An isolated form was diagnosed in 10.0% (n=2) of children, while 90.0% (n=18) had an associated form, of which 3 (16.7%) were complicated.
Results. At stage I, double-barrel separating colostomy was performed in 13 (65.0%) boys, double-barrel loop colostomy in 6 (30.0%) and final transversostomy in 1 (5.0%). In 2 children with esophageal atresia and lower tracheoesophageal fistula, separation of fistula and formation of primary esophageal anastomosis were performed after colostomy. In a child with duodenal atresia, an anastomosis was formed according to Kimura during colostomy removal. At stage II, posterior sagittal anorectoplasty was performed in 17 (85.0%) children; abdomino-perineal in 3 (15.0%), and in 1 (5.0%) child with sigmoid atresia, abdomino-perineal anorectoplasty with enterocyst, formation of transverse-sigmoid anastomosis and protective loop ascendostomy was performed. Stage III involved stoma closure in all patients.
Conclusions. Comprehensive diagnostics in newborns with RUF allows to identify associated developmental defects, especially those requiring staged and simultaneous operations. A differentiated approach to diagnostics, anorectoplasty methods, rehabilitation yielded good results in 68.4% and satisfactory in 31.6% of children.
The research was carried out according to principles of the Declaration of Helsinki, approved by Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research.
No conflict of interest was declared by author.
References
Abdalla WMA, De La Torre L. (2017). The high pressure distal colostogram in anorectal malformations: technique and pitfalls. J Pediatr Surg. 52(7): 1207-1209. https://doi.org/10.1016/j.jpedsurg.2017.03.050; PMid:28381335
Bischoff A, Peña A, Levitt MA. (2013). Laparoscopic-assisted PSARP - the advantages of combining both techniques for the treatment of anorectal malformations with recto-bladderneck or high prostatic fistulas. J Pediatr Surg. 48(2): 367-371. https://doi.org/10.1016/j.jpedsurg.2012.11.019; PMid:23414867
Brisighelli G, Lorentz L, Pillay T, Westgarth-Taylor CJ. (2020). Rectal perforation following high-pressure distal colostogram. Eur J Pediatr Surg Reports. 8(1): 39-44. https://doi.org/10.1055/s-0040-1709140; PMid:32550125 PMCid:PMC7224970
Danielson J, Karlbom U, Graf W, Wester T. (2017). Outcome in adults with anorectal malformations in relation to modern classification - which patients do we need to follow beyond childhood? J Pediatr Surg. 52(3): 463-468. https://doi.org/10.1016/j.jpedsurg.2016.10.051; PMid:27894765
Hageman IC, Midrio P, Van der Steeg HJJ, Jenetzky E et al. (2024). The European anorectal malformation network (ARM-Net) patient registry: 10-year review of clinical and surgical characteristics. Br J Surg. 31; 111(2). 1-8. https://doi.org/10.1093/bjs/znae019; PMid:38364059 PMCid:PMC10870250
Halleran DR, Ahmad H, Bates DG, Vilanova-Sanchez A et al. (2019). A call to ARMs: accurate identification of the anatomy of the rectourethral fistula in anorectal malformations. J Pediatr Surg. 54: 1708-1710. https://doi.org/10.1016/j.jpedsurg.2019.04.010; PMid:31076157
Holschneider AM, Hutson JM. (2006). Anorectal malformations in children. Embryology, Diagnosis, Surgical Treatment, Followup. Springer-Verlag Berlin Heidelberg: 480.
Hosokawa T, Yamada Y, Hsokawa M, Kikuchi S et al. (2018). Ultrasound imaging of the anorectal malformation during the neonatal period: a comprehensive review. Jpn J Radiol. 36(10): 581-591. https://doi.org/10.1007/s11604-018-0767-7; PMid:30120703
Hosokawa T, Yamada Y, Tanami Y, Sato Y et al. (2019). Comparison of diagnostic accuracy for fistulae at ultrasound and voiding cystourethrogram in neonates with anorectal malformation. Pediatr Radiol. 49(5): 609-616. https://doi.org/10.1007/s00247-018-04339-4; PMid:30666353
Husain M, Dutra-Clarke M, Lemieux B, Wencel M, Solomon B et al. (2018). Phenotypic diversity of patients diagnosed with VACTERL association. Am J Med Genet. 176(9): 1830-1837. https://doi.org/10.1002/ajmg.a.40363; PMid:30152190
Kraus SJ, Levitt MA, Peña A. (2018). Augmented-pressure distal colostogram: the most important diagnostic tool for planning definitive surgical repair of anorectal malformations in boys. Pediatr Radiol. 48(2): 258-269. https://doi.org/10.1007/s00247-017-3962-2; PMid:28840291
Levitt MA, Peña A. (2007). Anorectal malformations. Orphanet J Rare Dis. 26; 2: 33. https://doi.org/10.1186/1750-1172-2-33; PMid:17651510 PMCid:PMC1971061
Madhusmita, Ghasi RG, Mittal MK, Bagga D. (2018). Anorectal malformations: role of MRI in preoperative evaluation Indian. J Radiol Imaging. 28(2): 187-194. https://doi.org/10.4103/ijri.IJRI_113_17; PMid:30050242 PMCid:PMC6038223
Midrio P, Van Rooij IALM, Brisighelli G, Garcia A et al. (2020). Inter- and intraobserver variation in the assessment of preoperative colostograms in male anorectal malformations: an ARM-net consortium survey. Front Pediatr. 8: 571.1-571.7. https://doi.org/10.3389/fped.2020.00571; PMid:33072661 PMCid:PMC7531276
Pariza PC, Stavarache I, Dumitru VA, Munteanu O et al. (2021). VACTERL association in a fetus with multiple congenital malformations - Case report. J Med Life. 14(6): 862-867. https://doi.org/10.25122/jml-2021-0346; PMid:35126759 PMCid:PMC8811671
Peña A, Devries PA. (1982). Posterior sagittal anorectoplasty: important technical considerations and new applications. J Pediatr Surg. 17(6): 796-811. https://doi.org/10.1016/S0022-3468(82)80448-X; PMid:6761417
Podberesky DJ, Towbin AJ, Eltomey MA, Levitt MA. (2013). Magnetic resonance imaging of anorectal malformations. Magn Reson Imaging Clin N Am. 21(4): 791-812. https://doi.org/10.1016/j.mric.2013.04.010; PMid:24183526
Thomeer MG, Devos A, Lequin M, De Graaf N et al. (2015). High resolution MRI for preoperative work-up of neonates with an anorectal malformation: a direct comparison with distal pressure colostography/fistulography. Eur Radiol. 25(12): 3472-34479. https://doi.org/10.1007/s00330-015-3786-0; PMid:26002129 PMCid:PMC4636514
Westgarth-Taylor C, Westgarth-Taylor T, Wood R, Levitt M. (2015). Imaging in anorectal malformations: what does the surgeon need to know? South Afr J Radiol. 19(2): 903. https://doi.org/10.4102/sajr.v19i2.903
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Paediatric Surgery (Ukraine)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “PAEDIATRIC SURGERY. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).
Authors transfer the copyright to the Journal “PAEDIATRIC SURGERY.UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
