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Anatomical alterations following the 'PSARP' procedure: Correlating MRI findings with continence scores
Amr Abdelhamid AbouZeid1, Sherif Elhussiny Ibrahim2, Shaimaa Abdelsattar Mohammad3
1Pediatric Surgery Department, Faculty of Medicine, Ain-Shams University.
Purpose:
To identify anatomical aberrations following PSARP procedure by using MRI, while correlating MRI findings to clinical outcome.
Patients And Methods:
Between January 2014 and December 2017, we conducted our study on male patients with rectourethral fistula who underwent PSARP. Postoperative pelvic MRI studies were performed and correlated to their clinical continence scores (Rintala, and Krickenbeck classification).
Results:
The study included 31 patients. Fourteen patients were retrieved from the hospital records and accepted to participate in the study; while the remaining 17 were collected from the fecal incontinence clinic. Their age ranged from 40 to 156 months (mean 83) We divided patients in the study into two groups according to their Rintala continence scores: (Group A) 15 patients with low scores (10 or less); and (Group B) 16 patients with higher scores (more than 10). We detected wider pelvic hiatus (hiatus/PC ratio) and more obtuse anorectal angle in group A than B.
Conclusion:
Several anatomical alterations can be detected by MRI following the PSARP procedure that include abnormalities in the striated muscle sphincter (attenuation/deficiency), deviated neorectum, and presence of excessive perirectal fat. A widened pelvic hiatus and/or obtuse anorectal angle may correlate with poor fecal continence in these patients.
Level Of Evidence:
This is a case control study (level III evidence).
Insights
Magnetic resonance imaging (MRI) can detect anatomical changes after posterior sagittal anorectoplasty (PSARP), such as a wider pelvic hiatus and obtuse anorectal angle, which may indicate poorer fecal continence in male patients.
Area of Science:
- Pediatric Surgery
- Radiology
- Urology
Background:
- Posterior sagittal anorectoplasty (PSARP) is a surgical procedure for rectourethral fistula.
- Assessing long-term anatomical outcomes and their correlation with clinical results is crucial.
Purpose of the Study:
- To identify anatomical aberrations after PSARP using MRI.
- To correlate MRI findings with clinical outcomes in male patients.
Main Methods:
- A case control study involving male patients who underwent PSARP for rectourethral fistula.
- Postoperative pelvic MRI studies were correlated with Rintala and Krickenbeck continence scores.
- Patients were grouped based on continence scores to compare anatomical parameters.
Main Results:
- MRI revealed anatomical alterations including striated muscle sphincter abnormalities, deviated neorectum, and excessive perirectal fat.
- A wider pelvic hiatus (hiatus/PC ratio) and a more obtuse anorectal angle were observed in patients with lower continence scores.
- These findings suggest a correlation between specific anatomical changes and fecal continence outcomes.
Conclusions:
- MRI is effective in detecting anatomical abnormalities post-PSARP.
- Widened pelvic hiatus and obtuse anorectal angle are potential indicators of poor fecal continence.
- These anatomical findings can guide further management and counseling for patients.