Anterior Anus Research Articles

Outcomes of Management of Anterior Anus in Girls in Glasgow, UK

BackgroundAnterior anus is considered part of the spectrum of anorectal malformations in girls and has been associated with childhood constipation. However, limited literature exists on outcomes and associated malformations. MethodsAll girls <6 months referred to our centre with suspected anterior anus between January 2015 and December 2022 were identified. Data collected included patient demographics, presence of anomalies, operative management, laxative use and continence. Results are described using descriptive statistics and percentages. Results147 girls were referred with suspected anterior anus of which 95 were confirmed to have an anterior anus. Median age of first assessment was 3 (0–13) months. Median follow up was 24 (1–94) months. 21 (22.1 %) had clinical concern of partial absence of normal circumferential anal corrugation. 10 (10.5%) girls underwent examination under anaesthesia; 4 patients underwent anoplasty with covering colostomy. Laxatives were prescribed in 31 (32.6%) girls. Of the 53 patients followed up to age 4 years and older, 51 (96.2%) achieved continence. On renal ultrasonography significant hydroureteronephrosis was detected in one patient. No significant spinal anomalies were detected on imaging. Two patients had ventricular-septal defects were identified. All significant anomalies were in patients with an ectopic anus/ perineal fistula. ConclusionThis represents the largest reported series of girls with anterior anus. The incidence of identified associated malformations was low. Furthermore, laxative use and continence outcomes are similar to the general infant/childhood population. Screening and routine follow-up should be reserved for individual cases where there is clinical concern.

Characteristics and treatment of congenital perineal groove in male patients.

Congenital perineal groove (CPG) of male patients has rarely been reported before. The purpose of this study was to review our cases and describe their characteristics and treatment. Four male patients diagnosed with CPG were included in this study. Medical records were retrospectively reviewed. Type of CPG and anal position index (API) of the patients were recorded. Follow-up was through outpatient visits. Their age ranged from 4 years and 2 months to 10 years and 9 months. Among the four patients, two complained of intermittent CPG mucosal hemorrhage and the other two had mucous secreting and soiling. The API was 0.24, 0.35, 0.36, and 0.40 for each patient, respectively, all represented anterior displacement. Type of CPG for the four patients were all partial, and the sulcus was from the posterior perineum to the edge of anus. Two patients were associated with hydrocele, imperforated anus, and rectoperineal fistula; one patient had left varicocele; the remaining patient had sacrum split. All the patients had no postoperative complication, and during the follow-up period of 5-8 months, no symptoms recurred in the four patients; they all had normal defecation. Both genders share the common three characteristics. In addition, shortened perineum with anterior anus, association of perineal malformations, and partial type occurrence are the extra morphological features in male patients. Furthermore, CPG in males are rarely accompanied by urinary tract infection. Favorable prognosis could be reached after operation.

Clinical Differentiation between a Normal Anus, Anterior Anus, Congenital Anal Stenosis, and Perineal Fistula: Definitions and Consequences-The ARM-Net Consortium Consensus.

In the past, an anteriorly located anus was often misdiagnosed and treated as an anorectal malformation (ARM) with a perineal fistula (PF). The paper aims to define the criteria for a normal anus, an anterior anus (AA) as an anatomic variant, and milder types of ARM such as congenital anal stenosis (CAS) and PF. An extensive literature search was performed by a working group of the ARM-Net Consortium concerning the subject “Normal Anus, AA, and mild ARM”. A consensus on definitions, clinical characteristics, diagnostic management, and treatment modalities was established, and a diagnostic algorithm was proposed. The algorithm enables pediatricians, midwives, gynecologists, and surgeons to make a timely correct diagnosis of any abnormally looking anus and initiate further management if needed. Thus, the routine physical inspection of a newborn should include the inspection of the anus and define its position, relation to the external sphincter, and caliber. A correct diagnosis and use of the presented terminology will avoid misclassifications and allow the initiation of correct management. This will provide a reliable comparison of different therapeutic management and outcomes of these patient cohorts in the future.

Conservative management of anterior located anus: A medium-long term follow up

Background/PurposeThe anterior anus (AA) is a condition, almost exclusively present in females, in which the anus is located abnormally anterior along the perineal body, well separated from the vulva. Definition and treatment are still controversial. This study aimed to evaluate the medium-long term follow up of patients with AA conservatively managed, considering the gynaecologic aspects in post-menarchal girls. Matherials/MethodsThis cross-sectional study includes AA patients older than 3 years at time of the study, followed in two referral centres for ARM between January 2000 and May 2017. The API (Anal Position Index) was applied to define AA. A questionnaire regarding the ano-rectal function, occurrence of urinary infection (UTI), familiarity for ARM/AA was administered to parents and patients. Gynecological examination was performed in post-menarchal patients. ResultsFifty-three patients (all females) were retrieved. Three were excluded (2 underwent surgery at another center, 1 was lost at follow-up), 7/50 had major malformations (2 oesophageal atresia, 4 cardiovascular malformations and 1 with Fallot, uretheral duplicity and vertebral anomalies), 5/50 had familiarity for ARM/AA. Only 10% were constipated. Fifteen patients underwent gynecological examination. Their mean API was 0.278 +/- 0.013 DS, they had good buttock tropism, normal resident bacteria, and no UTI. ConclusionAA patients in our centers do not undergo any kind of surgery. At least three quarters of them have a perfectly normal bowel habits and adolescents do not present symptoms related to their condition. These results support the conservative management of this condition.

Anal ultrasonography in monitoring and postoperative evaluation of anorectal malformations

Objectives: We aimed to describe anal ultrasound for monitoring anorectal malformations. Methods: A descriptive and retrospective study of patients diagnosed and/or intervened with anorectal malformations rated by anal ultrasonography, between 2016-2017, was performed. We employed a transducer of 10 megahertz to identify the anatomy of the anal channel. Results: Eight patients, 5 men and 3 women were included, with a mean of 8.37 years old (range, 3-11). Three patients had a diagnosis of an anterior anus (not operated). Surgery was performed in 5 patients: 2 had a rectourethral fistula, 1 had a rectovesical fistula, and 1 had a rectovestibular and a perineal fistula. The most significant ultrasound findings were partial absence of the anterior part of the external sphincter, internal sphincter hypertrophy in the middle channel, and absence of internal sphincter in the median and high channel plus the absence of external sphincter in the anterior region. These results belonged to a patient with clinical incontinence and to 2 patients that were previously diagnosed with an anterior anus. Conclusions: Anal ultrasonography is a non-invasive method, economic, and feasible to be performed without anesthesia. It offers useful anatomical information to establish the best therapeutic option. Its main limitation is the unfeasibility of carrying it out on patients under 3 years old.

Perineal Groove: Report of Three Cases

Perineal groove is an unknown congenital anomaly of the lower perineum. It has been described as a congenital reddish wet sulcus extending from the fourchette to the anterior anus. The three cases hereby presented were first misdiagnosed. The aim of this presentation is to make pediatricians and paediatric dermatologists aware of this condition in order to avoid unnecessary interventions.

Reply by Authors

No AccessJournal of UrologyLetter to the Editor/Errata1 May 2017Reply by Authors View All Author Informationhttps://doi.org/10.1016/j.juro.2016.12.123AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Reply by Authors." The Journal of Urology, 197(5), pp. 1364–1365 References 1 : Bowel function and lower urinary tract symptoms in females with anterior anus treated conservatively: controlled outcomes into adulthood. J Pediatr Surg2015; 50: 1168. Google Scholar 2 : Bowel function and lower urinary tract symptoms in males with low anorectal malformations: an update of controlled, long-term outcomes. Int J Colorectal Dis2015; 30: 221. Google Scholar 3 : Bowel functional outcomes in females with perineal or vestibular fistula treated with anterior sagittal anorectoplasty: controlled results into adulthood. Dis Colon Rectum2015; 58: 97. Google Scholar 4 : Long-term bowel functional outcomes in rectourethral fistula treated with PSARP: controlled results after 4-29 years of follow-up: a single-institution, cross-sectional study. J Pediatr Surg2014; 49: 1635. Google Scholar 5 : Validation of the Erection Hardness Score. J Sex Med2007; 4: 1626. Google Scholar 6 : Bowel function and gastrointestinal quality of life among adults operated for Hirschsprung disease during childhood: a population-based study. Ann Surg2010; 252: 977. Google Scholar 7 : Bowel function and quality of life after transanal endorectal pull-through for Hirschsprung disease: controlled outcomes up to adulthood. Ann Surg2016; 10.1097/SLA.0000000000001695. Crossref, Google Scholar 8 : Health-related quality of life and parental stress in children with fecal incontinence: a normative comparison. J Pediatr Gastroenterol Nutr2016; 63: 633. Google Scholar 9 : Study of intestinal function in anorectal malformations: the role of bowel management in quality of life. Acta Biomed2016; 87: 197. Google Scholar 10 : Long-term disease-specific quality of life in children and adolescent patients with ARM. J Pediatr Surg2012; 47: 1317. Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 197Issue 5May 2017Page: 1364-1365 Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement PDF downloadLoading ...

Manometric findings in relation to functional outcomes in different types of anorectal malformations

AimsTo compare anorectal manometry (AM) in patients with different types of anorectal malformations (ARMs) in relation to functional outcomes. MethodsA single-institution, cross-sectional study. After ethical approval, all patients ≥7years old treated for anterior anus (AA), perineal fistula (PF), vestibular fistula (VF), or rectourethral fistula (RUF) from 1983 onwards were invited to answer the Rintala bowel function score (BFS) questionnaire and to attend anorectal manometry (AM). Patients with mild ARMs (AA females and PF males) had been treated with minimally invasive perineal procedures. Females with VF/PF and males with RUF had undergone internal-sphincter saving sagittal repairs. Results55 of 132 respondents (42%; median age 12 (7–29) years; 42% male) underwent AM. Patients with mild ARMs displayed good anorectal function after minimally invasive treatments. The median anal resting and squeeze pressures among patients with mild ARMs (60 cm H2O and 116 cm H2O respectively) were significantly higher than among patients with more severe ARMs (50 cm H2O, and 80cm H2O respectively; p≤0.002). The rectoanal inhibitory reflex was preserved in 100% of mild ARMs and 83% of patients with more severe malformations after IAS-saving sagittal repair. The functional outcome was poor in 4/5 patients with an absent RAIR (BFS≤11 or antegrade continence enema-dependence). Rectal sensation correlated significantly with the BFS. ConclusionsOur findings support the appropriateness of our minimally invasive approaches to the management of mild ARMs, and IAS-saving anatomical repairs for patients with more severe malformations. Level of evidence: III.

Bowel function and lower urinary tract symptoms in females with anterior anus treated conservatively: Controlled outcomes into adulthood

PurposeAnterior anus (AA) is a low type of anorectal malformation that is seen exclusively in females, characterized by an essentially normal appearing anus in an abnormally anterior position. In AA, the anal canal is located mostly within the voluntary sphincter complex, differentiating it from a perineal fistula in females, and allowing for a nonoperative approach to management. This study aimed to characterize the controlled, long-term bowel functional outcomes and lower urinary tract symptoms (LUTS) in females with conservatively treated anterior anus. MethodsA single-institution, cross-sectional study. All females treated conservatively for AA between 1983 and 2006 were invited to answer a postal questionnaire on bowel function and lower urinary tract symptoms. Each patient was matched by age and gender to 3 controls that had answered the same questionnaire. Ethical approval was obtained. ResultsAmong 45 respondents (67%; median age 10.2 (4–20) years), fecal continence was comparable to controls overall (p=NS). Constipation affected a significantly higher proportion patients (36%) than controls (13%; p=0.002) and tended to decline with age. Outcomes by bowel function score were good/normal in 93%, satisfactory in 7% and poor in none. Lower urinary tract symptoms and age at toilet training were comparable to controls (p=NS). ConclusionsUp to adulthood, long-term bowel functional outcomes comparable to matched peers can be achieved in nearly all of females with AA with conservative management alone, provided that effective control of constipation is achieved. The prevalence of LUTS is comparable to controls, and toilet training can be expected to occur at the normal age.

Phylogenetic relationships of the Chinese cyprinid genus Rhinogobio Bleeker (Teleostei: Cyprinidae) based on sequences of the mitochondrial DNA control region, with comments on character adaptations

Rhinogobio is a cyprinid genus restricted to the river drainages of China. Sequences of the mitochondrial DNA control region were determined for four Rhinogohio species and one outgroup species, Coreius heterodon, to investigate the phylogenetic relationships within the genus. The control region of the Rhinogobio species ranges from 922 to 930 base pairs and comprises 930 base pairs in Coreius. Our phylogenetic analysis indicates two distinct lineages in the genus Rhinogobio. The first includes only R. ventralis. In the second lineage there are three species, two closely related species R. cylindricus and R. hunanensis, and their sister species R. typus. An analysis of character adaptations suggests an evolutionary trend in this genus towards a relatively lower body and caudal peduncle depth, a shorter dorsal fin, and a more anterior anus. In addition, there is a trend towards shorter barbels and relatively larger eyes. Some or all of these traits may be associated with a habitat shift from fast-flowing turbid rivers to slower-flowing clear river habitats.

THE GENUS BERTHELLA BLAINVILLE, 1825 (NOTASPIDEA: PLEUROBRANCHIDAE) FROM MAGELLANIC WATERS

Only two notaspidean species are known from coldtemperate waters of South America. Both belong to the pleurobranchid genus Berthella Blainville, 1825, but their taxonomy is confused. This study gives detailed anatomical data on 13 specimens of B. platei Bergh, 1898, recently collected from southern Chile and two specimens from the Beagle Channel area dredged during the International ‘Victor Hensen’ Magellan Expedition, 1994. The major difference from previous descriptions is the absence of a vaginal duct connecting the seminal receptacles with the female glands. Berthella platei has three genital openings, but not a doridoidean-like triaulic genital arrangement; allosperm must exit from the vagina and enter the nidamental duct by an external groove. The anal opening is situated above the anterior half of the gill basement membrane. In its coloration, porous and notal texture, wider mantle and more anterior anus position B. platei clearly differs from the original description of B. patagonica (Orbigny, 1837) from Argentina. Re-examination of museum material shows that Bergh (1898) erroneously used central Chilean B. platei for his anatomical redescription of B. patagonica. One museum specimen of Berthella patagonica determined by Melvill & Standen from the Falklands is shown to be B. platei. Berthella platei thus ranges from central Chile to southernmost Patagonia and seems separated geographically from B. patagonica which is only known from northern Patagonia. The taxonomy of the latter species still remains unclear and requires reassessment.

The microscopic anatomy of the terminal intestinal canal in ectopic vulval anus

The deformity to which this paper refers is also termed the ectopic vestibular anus, the female anterior anus or type III imperforate anus with rectoperineal fistula. It is that deformity in which there is a separate terminal opening for the rectum situated on the surface within the posterior confines of the vulva immediately adjacent and posterior to the vaginal orifice. This investigation was undertaken in order to determine whether in this deformity the terminal intestinal canal possesses any of the microscopic anatomical features of a normal anal canal.