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

Abstract

We assessed continence after scope-assisted anorectovaginoplasty (SARVP) for female anorectal malformation (FARM). 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. 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). Scope assistance improves visualization, thus pelvic sphincter dissection/division is minimized with less detrimental impact on postoperative continence.