Intraoperative damage to the male urethra and pelvic visceral motor nerves during posterior sagittal anorectoplasty

Abstract

The use of the sagittal surgical approach to the rectum and urinary fistula in male patients with anorectal agenesis is addressed. Iatrogenic damage to the urethra (1 in 60 cases) and pelvic (2 in 60 cases) occurred when the operator had difficulty identifying the rectum intraoperatively and where inappropriate midline dissection was done. The importance of an adequate preoperative contrast rectogram and the intraoperative identification of the rectum with the aid of a catheter is emphazied. Perirectal blunt dissection is discouraged, the need for deep lateral directed tissue retraction is avoided by applying direct traction onto the freed rectum, and a long and wide portion of rectal wall is left in the midline on the urethra and bladder neck. The anatomy of the autonomic pelvic plexus at risk in the normal and congenitally abnormal case is described.