Types of Anorectal Defects in Males
The Colorectal Center at Cincinnati Children's Hospital Medical Center provides information about anorectal defects and treatments for males.
Primary approach without a colostomy in healthy full-term newborns, provided the surgeon has experience with such approach
Spectrum of Male Defects
Male defects, as in all anorectal malformations / imperforate anus, are part of a wide spectrum that goes from a very low and simple malformation such as the one shown below, to the extremely complex, with a rectobladder neck fistula, which is also shown below.
In between these two extremes are shown the rectourethral bulbar fistula and rectourethral prostatic fistula.
All attempts at classifying congenital defects run the risk of becoming arbitrary, because it must always be remembered that the surgeon is dealing with a spectrum. However, most anorectal defects that were seen in males by the author fall within these four categories.
Moving more toward the simpler side of the spectrum (low), there is a better chance of having a normal sacrum, good muscles, and a "good-looking perineum."
Moving toward the complex side, the chances significantly increase for having a very poorly developed sacrum and, therefore, poor innervation, underdeveloped muscles and narrow pelvis.
The potential for continence is obviously decreased. The space available through which to pull the rectum down is minimal and sometimes, despite maximum tailoring of the rectum, the goal of putting the rectum within the muscle structures cannot be achieved.
In extremely poor cases, the surgeon will find it very difficult to identify the muscle structures typically seen in good cases of anorectal defects.
A rectobladder fistula occurred in about 10 percent of the author's series and that is the one specific type of defect that will require an abdominal or or laparoscopic approach in addition to the posterior sagittal operation. The rest, in the author's experience, can be repaired purely through the posterior sagittal incision.
For more information or to request an appointment, please contact the Colorectal Center at Cincinnati Children's.
