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Fecal and urinary continence after scope-assisted anorectovaginoplasty for female anorectal malformation

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Abstract

Aim

We assessed continence after scope-assisted anorectovaginoplasty (SARVP) for female anorectal malformation (FARM).

Methods

Five FARM cases were assessed; cases 1 and 2: cloacal malformation; case 3: urogenital sinus, and rectovestibular fistula (RF); case 4: RF, absent vagina, and sacral anomaly; case 5: covered cloacal exstrophy. Treatment was SARVP in all cases, with perineal vaginoplasty (case 1), vagina pull-through (PT) similar to Georgeson’s colon PT (case 2), and the use of the native RF/cloaca channel as a vagina (cases 3–5). Continence was assessed pre and postoperatively.

Results

SARVP was performed in the lithotomy position without repositioning. Mean age at surgery was 3.2 (1.7–5.5) years. Current mean age: 8.8 years (range 7.5–12.2). Mean follow-up: 5.7 years. Preoperative continence: fecal: all had stomas; urinary: cases 1 and 2: continent; cases 3–5: incontinent. Postoperative continence: fecal: cases 1–3: continent; case 4: incontinent; case 5: awaiting stoma closure; urinary: cases 1 and 2: continent; cases 3 and 4: incontinent; case 5: continent (intermittent catheterization). Fetal continence evaluation questionnaire (CEQ) scores for cases 1–4 were 7.5, 9, 10, and 2 (maximum score 10, mean 7.1).

Conclusion

Scope assistance improves visualization, thus pelvic sphincter dissection/division is minimized with less detrimental impact on postoperative continence.

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Acknowledgments

This study was supported in part by a Grant-in-Aide (S0991013) from the Ministry of Education, Culture, Sport, Science, and Technology, Japan (MEXT) through the Foundation for Strategic Research Projects in Private Universities.

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Authors and Affiliations

  1. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Atsuyuki Yamataka, Shumpei Goto, Yoshifumi Kato, Hiroyuki Koga, Geoffrey J. Lane & Tadaharu Okazaki

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  1. Atsuyuki Yamataka
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  2. Shumpei Goto
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  3. Yoshifumi Kato
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  4. Hiroyuki Koga
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  5. Geoffrey J. Lane
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  6. Tadaharu Okazaki
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Correspondence to Atsuyuki Yamataka.

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Yamataka, A., Goto, S., Kato, Y. et al. Fecal and urinary continence after scope-assisted anorectovaginoplasty for female anorectal malformation. Pediatr Surg Int 28, 907–912 (2012). https://doi.org/10.1007/s00383-012-3141-3

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  • DOI: https://doi.org/10.1007/s00383-012-3141-3

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