Repair of congenital H-type vestibuloanorectal fistula through the posterior midsagittal approach: case report.

The posterior midsagittal approach was successfully used for the repair of congenital H-type vestibuloanorectal fistula in a patient 1.5 months old. Technical details of the operation which consisted of two main parts are described. Identification and dissection of the fistulous tract started following midsagittal division of the sphincters and the posterior half of the rectum with the patient in a knee-chest position. The dissected part of the fistulous tract was inverted per vagina. Completion of dissection and excision of the fistulous tract were accomplished with the patient in the lithotomy position. The main advantage of the procedure was the ability to completely excise the fistula under direct vision.

Urethral advancement, glanduloplasty and preputioplasty in distal hypospadias.

One hundred and thirty boys with subcoronal (78) and subglandular (52) hypospadias were submitted to Urethral Advancement, Glanduloplasty and Preputioplasty (URAGP). The main steps of the operation were the following: blunt dissection and mobilization of the urethra as extensively as needed to reach the tip of the glans without tension; embedding of the urethra into a groove of the glans created by excision of tissue between two incisions converging from each side of the primary meatal location up to the tip of the glans; fixation of the meatus up to the tip of the glans and suturing of the glandular flaps over the mobilized urethra; shaping the foreskin to normal appearance. Reconstruction was uncomplicated in 117 patients (90%). Postoperative fistulae and urethral retraction to an abnormal position occurred in 7 and 6 cases respectively. All meatal retractions and 2 fistulae next to the meatus were dealt with successfully using the Mathieu procedure. On the basis of this experience we conclude that the technique is applicable to any type of distal hypospadias regardless of the severity of glandular ventriflexion, it is amenable to the Mathieu procedure in case of failure and gives good functional and cosmetic results.