The anterior sagittal transrectal approach (ASTRA) for cases associated with rectal implantation of the urethra: A retrospective review of six cases

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dc.citation.issue6
dc.citation.volume13
dc.contributor.authorMacedo, A., Jr. [UNIFESP]
dc.contributor.authorSilva, M. I. S.
dc.contributor.authorPompermaier, J. A.
dc.contributor.authorOttoni, S. L.
dc.contributor.authorde Castro, R.
dc.contributor.authorLeal da Cruz, M.
dc.coverageOxford
dc.date.accessioned2020-09-01T13:21:04Z
dc.date.available2020-09-01T13:21:04Z
dc.date.issued2017
dc.description.abstractIntroduction Severe genital abnormalities such as urogenital sinus and urethral duplication with ectopic urethra in the rectum represent a major challenge in reconstructive urology. Objective We aimed to review our cases presenting with functional ectopic urethra implanted in the rectum that were treated through an ASTRA approach. Methods We reviewed the medical records of all patients who had undergone an ASTRA approach from 2005-2016. We collected data with interest to primary diagnosis, clinical presentation, additional procedure, immediate clinical outcome, complications, bowel habits after surgery, voiding and bladder emptying pattern and long term follow-up. Results Since 2005, we treated 6 cases using this method, consisting of 3 patients with congenital aphallia and 3 with Y-type urethral duplication. Two aphallia patients underwent De Castro's neophalloplasty with simultaneous anastomosis of proximal urethra to a tubed buccal mucosa neourethra and one had a neophalloplasty with transverse skin flaps and primary perineal urethrostomy. Two patients with Y-type urethral duplication had a complete urethroplasty performed (one end-to-end anastomosis and a two-stage repair). Last patient had a definitive perineal urethrostomy. At mean follow-up of 83.5 meses, only one patient voids through the urethra, four have a Mitrofanoff channel and two have a perineal urethrostomy. Immediate follow-up was uneventful and none of our patients had any bowel complications nor fecal incontinence. Discussion Domini et al. were the first proponents of the anterior sagittal transanorectal approach (ASTRA) as an alternative to classic Pena approach. Later, De Castro popularized specifically this technique as a relevant part of his neophalloplasty procedure to treat congenital aphallia. We did not find in this series any complications related to ASTRA technique in regards to bowel habits, fecal incontinence or infection but most of cases we tried to create a new anterior urethra and connect to the proximal stump failed. Moreover, we are skeptic to support simultaneous urethral repair when there is a dysplastic bulbar segment between the proximal stump and the end of the penile urethra normally at penoscrotal junction area by urethral duplication. Treatment at two-stages is also prone to fail in the midterm. At end, most of them will have either a Mitrofanoff or perineal urethral stoma as shown in our data. Conclusion The ASTRA approach proved to be useful for cases of rectal implantation of the urethra. No complications related to anterior sphincter incision were documented. We believe it should be regarded as the treatment of choice for cases alike ours.en
dc.description.affiliationCACAU NUPEP, Dept Urol, Sao Paulo, Brazil
dc.description.affiliationUniv Fed Sao Paulo, Dept Pediat, Sao Paulo, Brazil
dc.description.affiliationHosp CdC Petrucciani, Dept Pediat Surg, Lecce, Italy
dc.description.affiliationUnifespUniv Fed Sao Paulo, Dept Pediat, Sao Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent-
dc.identifierhttp://dx.doi.org/10.1016/j.jpurol.2017.04.011
dc.identifier.citationJournal Of Pediatric Urology. Oxford, v. 13, n. 6, p. -, 2017.
dc.identifier.doi10.1016/j.jpurol.2017.04.011
dc.identifier.issn1477-5131
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/58077
dc.identifier.wosWOS:000418045800017
dc.language.isoeng
dc.publisherElsevier Sci Ltd
dc.relation.ispartofJournal Of Pediatric Urology
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectASTRAen
dc.subjectUrethral duplicationen
dc.subjectSurgeryen
dc.titleThe anterior sagittal transrectal approach (ASTRA) for cases associated with rectal implantation of the urethra: A retrospective review of six casesen
dc.typeinfo:eu-repo/semantics/article
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