Taking “Trans-ano-rectal” out of ASTRA: An anterior sagittal approach without splitting the rectum

  • Kathy H. Huen
    Correspondence
    Correspondence to: Kathy H. Huen, Fellow in Pediatric Urology, Children's Hospital of Orange County and UC Irvine Health, 505 S. Main Street, Ste 100, Orange, CA 92868, USA, Tel.: +(401) 556 0410; fax: +(714) 509 3915
    Affiliations
    Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA

    Department of Urology, University of California Irvine School of Medicine, Orange CA, USA
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  • Sarah A. Holzman
    Affiliations
    Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA

    Department of Urology, University of California Irvine School of Medicine, Orange CA, USA
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  • Carol A. Davis-Dao
    Affiliations
    Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA
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  • Elias J. Wehbi
    Affiliations
    Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA

    Department of Urology, University of California Irvine School of Medicine, Orange CA, USA
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  • Antoine E. Khoury
    Affiliations
    Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA

    Department of Urology, University of California Irvine School of Medicine, Orange CA, USA
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Published:December 21, 2021DOI:https://doi.org/10.1016/j.jpurol.2021.12.007

      Summary

      The anterior sagittal trans-ano-rectal approach (ASTRA) provides excellent exposure to the urethra and vagina for partial or total urogenital sinus mobilization and subsequent reconstruction for patients with urogenital sinus anomalies. It is a frequent approach to reconstruction for children with a high confluence. However, the division of the anterior anal external sphincter and the rectal wall in the ASTRA incurs morbidity, which include fecal incontinence if one veers from the midline, and increased risk of wound infection due to fecal soilage. We demonstrate a modified technique to the ASTRA without dividing the anterior anal sphincter and rectal wall, with achievement of comparable exposure and excellent vaginal mobilization and length.

      Keywords

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      Reference

        • Leite M.T.C.
        • Fachin C.G.
        • de Albuquerque Maranhão R.F.
        • Shida M.E.F.
        • Martins J.L.
        Anterior sagittal approach without splitting the rectal wall.
        Int J Surg Case Rep. 2013; 4: 723-726