Posterior Sagittal Approach with Perirectal Dissection (PSAPD) for Urogenital Anomalies Andrew B. Pinter, Andrew Hock, Attila M. Vastyan, Andrew Farkas, Zsolt Oberritter University of Pecs/Hungary, Faculty of Medicine, Department of Paediatrics, Surgical Unit

P osterior S agittal A pproach with P erirectal D issection PSAPD

Pena A., Amroch D., Baeza C. et al: Pena A., Amroch D., Baeza C. et al: THE EFFECT OF THE POSTERIOR SAGITTAL APPROACH ON RECTAL FUNCTION (experimental study) THE EFFECT OF THE POSTERIOR SAGITTAL APPROACH ON RECTAL FUNCTION (experimental study) J. Pediatr. Surg. 28: , J. Pediatr. Surg. 28: , 1993.

Pinter AB; Hock A; Vastyan A; Farkas A Pinter AB; Hock A; Vastyan A; Farkas A Does the Posterior Sagittal Approach With Perirectal Dissection Impair Fecal Continence in a Normal Rectum? Does the Posterior Sagittal Approach With Perirectal Dissection Impair Fecal Continence in a Normal Rectum? J. Pediatr. Surg. 31: , J. Pediatr. Surg. 31: , 1996.

Indications for PSAPD high vaginal atresia high vaginal atresia iatrogenic or post-traumatic fistulas iatrogenic or post-traumatic fistulas vesico-vaginal vesico-vaginal urethro-vaginal urethro-vaginal prostatic rhabdomyosarcoma prostatic rhabdomyosarcoma Müllerian duct cysts Müllerian duct cysts seminal vesical cysts seminal vesical cysts intersex disorders intersex disorders

Short-term follow-up (24 months) bowel habits bowel habits anorectal manometry anorectal manometry urinary manometry urinary manometry

Long-term follow-up Modified Holschneider’s Modified Holschneider’s scoring scoring Anal manometry Anal manometry

Fecal continence scoring 2 patients 26 points 2 patients 26 points 5 patients23-25 points 5 patients23-25 points 1 patient 15 points 1 patient 15 points

Advantages of Posterior Sagittal Approach with Perirectal Dissection (PSAPD) no diverting colostomy and closing the stoma no diverting colostomy and closing the stoma no longitudinal incisions of the posterior and anterior rectal walls no longitudinal incisions of the posterior and anterior rectal walls no need for rectal dilatation no need for rectal dilatation better visual control better visual control more place for surgery more place for surgery

Exquisite sensation Exquisite sensation Proprioception Proprioception

Conclusion The posterior saggital approach with perirectal dissection is suitable for correction of complicated congenital and acquired disorders of the genitourinary tract in children who have a normal rectum The posterior saggital approach with perirectal dissection is suitable for correction of complicated congenital and acquired disorders of the genitourinary tract in children who have a normal rectum It does not cause fecal incontinence It does not cause fecal incontinence

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