The anterior sagittal transrectal approach (ASTRA) for cases associated with rectal implantation of the urethra: A retrospective review of six cases

Y-type Urethral Duplication with Rectal Implantation of the Urethra in a Boy with Long-gap Esophageal Atresia: A Case Report

“…The Y-subtype represents 6-30% of all urethral duplications. [11][12][13][14] A special form of Y-type duplication represents urethral duplication with rectal or perineal implentation of the urethra (type IIA2 according to Effmann's classification). Usually, single case reports and few case series were published.…”

“…Usually, single case reports and few case series were published. [11][12][13][14][15] We report a case of newborn male with multiple congenital anomalies and Y-type II a urethral duplication with rectal implantation.…”

“…For those reasons, vesicostomy was performed to avoid potential urinary tract infections. In the future, anterior sagittal transrectal approach (ASTRA) procedure to separate the ventral, functioning urethra from the rectum leaving a definitive perineal urethrostomy, was planned as proposed by Macedo et al [14,16] DISCUSSION Y-type urethral duplication according to Effmann's classification is categorized as type IIA2 anomaly. In this condition, ventral urethra originates from the bladder neck or posterior urethra and is opened either in the perineum or within the rectum and dorsal dysplastic urethra opens within the glans.…”

“…Various operative techniques were proposed. [11][12][13][14] Reconstruction of penile urethra is more challenging option and usually needs multistage procedures and is prone to reoperations and failure. [11] Recently, the ASTRA approach with repositioning of functioning, ventral urethra implanted in the rectum to perineal position as a perineal urethrostomy is strongly advocated.…”

“…Removal of dysplastic urethra following the ASTRA approach seems to be safe and feasible. [14,16] We planned for our patient in whom also abnormal structure of the penis is present to perform the same procedure after restoring the continuity of the digestive tract.…”