Macedo et al. (11. 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....
) 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 (22. 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.). 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 (33. Onofre LS, Leão JQ, Gomes AL, Heinisch AC, Leão FG, Carnevale J. Pelvic fracture urethral distraction defects in children managed by anterior sagittal). This video, when combined with the authors’ previous work, provides a useful reference to anyone planning to use this technique (44. trans anorectal approach: a facilitating and safe access. J Pediatr Urol. 2011;7:349-55.).
Hubert Swana, MD
Pediatric Urology
Nemours Children’s Hospital Orlando
Orlando, FL, USA
E-mail: hswana@nemours.org
REFERENCES
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1Macedo 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 -
2Di 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.
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3Onofre LS, Leão JQ, Gomes AL, Heinisch AC, Leão FG, Carnevale J. Pelvic fracture urethral distraction defects in children managed by anterior sagittal
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4trans anorectal approach: a facilitating and safe access. J Pediatr Urol. 2011;7:349-55.
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5Macedo 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
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Publication in this collection
Jan-Feb 2017