Acquired posterior urethral diverticulum following surgery for anorectal malformations
Shumyle Alam1, Taiwo A Lawal, Alberto Peña
1Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. shumyle.alam@cchmc.org
Insights
Posterior urethral diverticulum is a complication of anorectal malformations (ARMs) surgery. Early detection and excision of urethral diverticula are crucial for optimal outcomes in pediatric patients.
Area of Science:
- Pediatric Surgery
- Urology
- Congenital Malformations
Background:
- Anorectal malformations (ARMs) surgery has advanced, but complications persist.
- Posterior urethral diverticulum is a recognized, potentially severe complication of ARM repair.
Purpose of the Study:
- To review the presentation, treatment, and outcomes of male patients with posterior urethral diverticulum after ARM surgery.
- To highlight the importance of recognizing and managing this complication.
Main Methods:
- Retrospective cohort review of male patients with persistent problems post-ARM repair.
- Analysis of 29 patients presenting with urethral diverticulum, including malformation type, prior repair, presentation, treatment, and follow-up.
Main Results:
- Twenty-nine male patients with urethral diverticulum were identified.
- Urinary complaints were the most common presenting symptom; 28 patients underwent reoperation.
- All diverticula were repaired via a posterior sagittal approach; one case revealed adenocarcinoma.
Conclusions:
- The posterior sagittal incision has reduced the incidence of acquired posterior urethral diverticulum.
- Laparoscopic approaches for ARMs may theoretically increase diverticulum incidence.
- Prompt detection and surgical excision of posterior urethral diverticulum are recommended.
Purpose:
Despite significant advances in the surgical management of anorectal malformations (ARMs), many children still experience significant debilities from potentially avoidable complications. One complication, the posterior urethral diverticulum, may have untoward consequences if not recognized and treated.
Methods:
A retrospective cohort review was undertaken of male patients who presented to us with persistent problems after being operated on elsewhere for ARM. Twenty-nine patients presented with a urethral diverticulum. Their charts were reviewed for the type of malformation, prior repair, presentation, treatment, and postoperative follow-up.
Results:
Twenty-nine patients were identified that fit the criteria for this study. To date, 28 patients have been managed with reoperation. Urinary complaints were the most common presenting symptoms. All patients were repaired using a posterior sagittal approach. Pathology of the diverticulum in one patient revealed a well-differentiated mucinous adenocarcinoma.
Conclusion:
The incidence of acquired posterior urethral diverticulum has decreased with the popularization of the posterior sagittal incision. There is a theoretical concern that the incidence may increase with the use of laparoscopy for the treatment of ARMs especially those where the fistula is below the peritoneal reflection. Once detected, the diverticulum should be excised.
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