Urologic Injuries Consecutive to the Surgical Treatment of Anorectal Malformations in Male Patients
By Alberto Peña, MF Acuña and A Hong
The overwhelming majority of male patients with anorectal malformations have a fistula between the rectum and the urethra or bladder.
The rectum must be separated from the urinary tract as a mandatory step to repair the malformation. Consequently, serious injuries may be inflicted to the bladder, urethra, prostate, seminal vesicle, ureters, and important nerves.
One thousand and three (1,003) male patients were retrospectively studied: 572 had a posterior sagittal operation done by us, and 431 were operated on at other institutions.
In the group operated by us, 2 vas deferens and 2 ureters were accidentally divided. In 6 cases, a seminal vesicle was opened and closed, and in another 7 cases the urethra was opened and closed during the repair. No late sequelae were observed.
In the group of 431 patients operated on at other institutions, 97 suffered serious urologic injuries, including 27 neurogenic bladder; 12 urethral injuries that provoked stenosis; 23 posterior urethral diverticulums; 28 recurrent or persistent fistulae; 7 acquired urethral atresia; and 4 division of vas deferens.
The operative reports were studied looking for possible explanations for the injuries. The most common and serious error occurred when surgeons explored the patients, looking for a rectum, without a previous distal colostogram.
Frequently, the surgeon was unable to find the rectum but rather found and injured important urogenital structures. Other errors are analyzed and discussed.
Serious urogenital injuries may occur during the repair of these defects. These patients should not be explored without knowing the exact location of the rectum.
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