From
Colorectal Channel
A Complex Urogenital Malformation: Urogenital Sinus with Normal Anus
Chapter 1 of 3 · Case-Based Learning
Case planning
Case presentation and surgical planning for urogenital sinus variants
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Cystoscopy revealed a long common channel and a short urethra in this case.
When there is a long common channel and short urethra, the surgical plan is to separate the vagina from the common channel and allow the common channel plus the native urethra to become the neourethra.
The trans-anorectal approach is an extension of the ASTRA concept, which is incision of the anterior anus only.
The posterior urethra is repaired in two layers after mobilizing the anterior vaginal wall and identifying the fistula.
An ischiorectal fat pad is used to cover the posterior urethral repair.
The most common type of urogenital sinus has a long urethra and a short common channel.
For a urogenital sinus with long urethra and short common channel, a transperineal total urogenital mobilization is appropriate to gain better exposure to the urogenital complex.
An ASTRA approach involves incising the anterior wall of the rectum to gain more exposure.
A trans-anorectal approach can be performed with extension to include the posterior sagittal incision.
For a urogenital sinus with normal anus, there are two surgical options: total urogenital mobilization for a short common channel and long urethra, and urogenital separation for a long common channel and short urethra.