Rectovestibular fistula with vaginal atresia: our experience and a proposed course of management

Kisku, Sundeep; Barla, Ravi Kishore; Sen, Sudipta; Karl, Sampath; Mathai, John; Varghese, Lilly

doi:10.1007/s00383-014-3517-7

Cited by 10 publications

(8 citation statements)

References 28 publications

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“…We would argue against the use of the distal rectal fistula as neovagina because we think that it has an important role in optimizing a patient's future continence and that the rectum should be kept as rectum. 4,33 Sigmoid colovaginoplasties were first reported in 1904 40 and stenosis is rare apart from at the introitus. 41 There have been concerns about excessive mucus production; however, only two of the reports in this review mentioned this as an outcome and neither found it to be problematic.…”

Section: Discussionmentioning

confidence: 99%

Menstrual, Sexual, and Obstetrical Outcomes after Vaginal Replacement for Vaginal Atresia Associated with Anorectal Malformation

et al. 2016

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The authors of this article became aware of significant differences in the management of two females with a rectovestibular fistula and associated vaginal agenesis. In one patient, a sigmoid colovaginoplasty was performed at the time of the posterior sagittal anorectoplasty (PSARP), and the other underwent repair of the rectovestibular fistula with a primary PSARP, but the surgeons elected to delay the timing of vaginal reconstruction. We decided to review the literature, to establish if recommendations could be made to optimize the management of these children based on current evidence. A literature review was conducted to determine the management and long-term outcomes in patients with an anorectal malformation and associated vaginal atresia. Specific gynecological outcomes assessed were menstrual egress and adequacy of the vaginal replacement for penile-vaginal intercourse. Eighty-eight cases were included in the review. Age at diagnosis had a bimodal distribution: 0 to 5 years, 56%; >10 years, 37%. Vaginal atresia was recognized before the operation in 45 patients. Types of vaginal atresia encountered were: (a) distal vaginal atresia ( = 17), (b) vaginal agenesis with absent Mullerian development ( = 47), (c) vaginal agenesis with variable Mullerian development ( = 17), and (d) cervico-vaginal agenesis ( = 7). Types of vaginal replacement used were sigmoid colovaginoplasty ( = 26), distal rectal fistula as neovagina ( = 30), terminal ileum ( = 5), vaginal pull-through ( = 9), and others/unknown ( = 8). Two patients followed a perineal dilatation program and nine patients await reconstruction. Median follow-up was 18 months (6 weeks to 31 years). Long-term menstrual outcomes were reported in 18 (21%) patients. Sexual function was reported in 10 (11%) patients. Three pregnancies were reported but none resulted in live births. Vaginal atresia is often missed in association with ARMs. Management should be in collaboration with pediatric gynecologists. Due to a lack of long-term outcome data, no definite conclusion can be drawn for the best technique, tissue, or timing of vaginal replacement. The opportunity to perform vaginal replacement in conjunction with the rectal repair may be worth considering because of a shallower pelvis, nonscarred tissue planes, and the excellent surgical exposure.

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Section: Discussionmentioning

confidence: 99%

Menstrual, Sexual, and Obstetrical Outcomes after Vaginal Replacement for Vaginal Atresia Associated with Anorectal Malformation

et al. 2016

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“…6 On perineal examination, such a patient has a normal urethra, normal vagina, and another orifice (rectal fistula in the vestibule). 7 8 Herein we present a case of an extremely rare anorectal malformation of rectourethral fistula in a female that, to our knowledge, has not been described previously in the literature. In review of senior authors' series of over 1,000 primary ARM patients, this is the only such case.…”

Section: Discussionmentioning

confidence: 88%

Imperforate Anus and Rectourethral Fistula in a Female

Ahmad

Halleran

DaJusta

et al. 2019

European J Pediatr Surg Rep

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Anorectal malformations (ARM) are complex, heterogeneous disorders and in females the most common anomaly is imperforate anus with a rectovestibular fistula. We describe a malformation not previously encountered in the literature: imperforate anus associated with a normal urethra, normal vagina, but with a recto urethral fistula. Rectourethral fistula in a female is an extremely rare ARM. Precise workup is required to clarify the anatomy for operative planning.

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“…These include excessive mucosal discharge, bowel obstruction, anastomotic leaks, bladder/ureteral injury, stenosis, prolapse, polyp formation, diversion colitis, ulcerative colitis and rarely malignancy [1,15]. Despite these complications, several authors have reported successful bowel vaginoplasties [1,2,4,15,16]. Clearly, the multiplicity of procedures for this complex anomaly indicates that there is no perfect solution.…”

Section: Discussionmentioning

confidence: 99%

“…Our experience is in agreement with that observed by Levitt et al in that it would be better to use the ARVF as the neoanus. The neovagina may be created at the same operation, or in our opinion, at puberty, when the uterine structures can be assessed for anastomosis with the bowel segment [16].…”

Section: Discussionmentioning

confidence: 99%

Bowel vaginoplasty in children and young women: an institutional experience with 55 patients

et al. 2015

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Rectovestibular fistula with vaginal atresia: our experience and a proposed course of management

Abstract: We recommend the rectovestibular fistula be used as the neoanus and not as the neovagina. Delayed bowel vaginal replacement has excellent results and allows for optimal assessment of functioning uterine body or remnants.

Cited by 10 publications

References 28 publications

Menstrual, Sexual, and Obstetrical Outcomes after Vaginal Replacement for Vaginal Atresia Associated with Anorectal Malformation

Menstrual, Sexual, and Obstetrical Outcomes after Vaginal Replacement for Vaginal Atresia Associated with Anorectal Malformation

Imperforate Anus and Rectourethral Fistula in a Female

Bowel vaginoplasty in children and young women: an institutional experience with 55 patients

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