Editorial Comment: Megalourethra and urethrorectal fistula: a rare presentation and a challenging reconstruction

Macedo et al. (¹) present a video that elegantly demonstrates a one-stage repair for a child with a urethrorectal fistula along with a megalourethra. The anterior sagital trans-ano-rectal approach (ASTRA) was first described by Di Benedetto and Di Benedetto for use in clitoro-vaginoplasty (²). The ASTRA approach allows careful separation of the urethra and the rectum. It has proven to be useful in the treatment of urethral trauma, urogenital sinus anomalies, and urethral duplications (³). This video, when combined with the authors’ previous work, provides a useful reference to anyone planning to use this technique (⁴).

Hubert Swana, MD
Pediatric Urology
Nemours Children’s Hospital Orlando
Orlando, FL, USA
E-mail: [e-mail]

REFERENCES

• ¹
  Macedo A Jr, Ottoni SL, Parizi JL, Martins GM, Garrone G, Cruz ML. Megalourethra and urethrorectal fistula: a rare presentation and a challenging reconstruction. Int Braz J Urol. 2016 Sep 30;42. doi: 10.1590/S1677-5538.IBJU.2015.0676. [Epub ahead of print]
  » https://doi.org/10.1590/S1677-5538.IBJU.2015.0676
• ²
  Di Benedetto V, Di Benedetto A. Introduction of the anterior sagittal trans-ano-rectal approach (ASTRA) as a technical variation of the Passerini-Glazel clitoro-vaginoplasty: preliminary results. Pediatr Med Chir. 1997;19:273-6.
• ³
  Onofre LS, Leão JQ, Gomes AL, Heinisch AC, Leão FG, Carnevale J. Pelvic fracture urethral distraction defects in children managed by anterior sagittal
• ⁴
  trans anorectal approach: a facilitating and safe access. J Pediatr Urol. 2011;7:349-55.
• ⁵
  Macedo A Jr, Rondon A, Bacelar H, Ottoni S, Liguori R, Garrone G, et al.. Urethral duplication II-A Y type with rectal urethra: ASTRA approach and túnica vaginalis flap for first stage repair. Int Braz J Urol. 2012;38:707; discussion 708.

Publication Dates

• Publication in this collection
  Jan-Feb 2017