Lessons learned from lower urinary tract complications of anorectoplasty for imperforate anus with rectourethral/rectovesical fistula: Laparoscopy-assisted versus posterior sagittal approaches

Purpose To report the sequelae of and preventive strategies for selected lower urinary tract (LUT) complications, i.e., posterior urethral diverticulum (PUD), intraoperative LUT injuries, postoperative dysuria, fistula recurrence in male imperforate anus (IA) with rectourethral/rectovesical (RU/RV) after laparoscopy-assisted anorectoplasty (LAARP) or sagittal (PSARP). Methods 153 boys IA RU/RV treated 1986–2019 by LAARP (n = 56) PSARP 97) at two unrelated institutes were studied retrospectively. Results After mean follow-up 17.0 years (range: 36.5 days-32.0 years), overall incidences complications were: (6/56; 10.7%); (7/97; 7.2%); p 0.55, comprising PUD: 5), 0); 0.006; injuries: 0), 5); 0.16; dysuria: 1), 1); p>0.999; recurrence: p>0.999. Mean onset PUD was 5.1 1.0–15.1 years). Treatment: surgery 2/5), conservative 3/5); repair 5/5); 2/2), redo 1/1). Conclusions Strategies devised to improve dissection accuracy resolved specific technical issues causing (remnant RU blind access PSARP). Currently, incidence new cases injuries is zero. Level Evidence: III