Anterior sagittal approach without splitting the rectal wall

Area of Science:

• Urology
• Pediatric Surgery
• Surgical Innovation

Background:

• The anterior sagittal transrectal approach (ASTRA) is widely used for proximal urethral lesions.
• ASTRA offers superior exposure compared to traditional perineal approaches.
• Rectal sectioning in ASTRA may contribute to morbidity.

Purpose of the Study:

• To evaluate the feasibility and outcomes of an anterior sagittal approach without rectal sectioning.
• To assess the efficacy of this modified technique in treating various pelvic disorders.

Main Methods:

• An anterior sagittal approach was performed without sectioning the rectal wall in three distinct clinical cases.
• Procedures included vaginoplasty for congenital adrenal hyperplasia, and treatment for paradoxical urinary incontinence in patients with hypospadias and gonadal dysgenesis.

Main Results:

• The modified anterior sagittal approach provided excellent surgical exposure to the posterior urethra.
• The technique was successfully applied in diverse pelvic reconstructive surgeries.

Conclusions:

• An anterior sagittal approach without rectal sectioning is a feasible and safe alternative.
• This method reduces morbidity by avoiding rectal wall division and repair.
• It effectively addresses posterior urethral anomalies while maintaining fecal continence.