title: Acquired posterior urethral diverticulum following surgery for anorectal malformations.
abstract: OBJECTIVE
  Despite significant advances in the surgical management of anorectal malformations (ARMs), many children still experience significant debilities from potentially avoidable complications. One complication, the posterior urethral diverticulum, may have untoward consequences if not recognized and treated.
  
  
  METHODS
  A retrospective cohort review was undertaken of male patients who presented to us with persistent problems after being operated on elsewhere for ARM. Twenty-nine patients presented with a urethral diverticulum. Their charts were reviewed for the type of malformation, prior repair, presentation, treatment, and postoperative follow-up.
  
  
  RESULTS
  Twenty-nine patients were identified that fit the criteria for this study. To date, 28 patients have been managed with reoperation. Urinary complaints were the most common presenting symptoms. All patients were repaired using a posterior sagittal approach. Pathology of the diverticulum in one patient revealed a well-differentiated mucinous adenocarcinoma.
  
  
  CONCLUSIONS
  The incidence of acquired posterior urethral diverticulum has decreased with the popularization of the posterior sagittal incision. There is a theoretical concern that the incidence may increase with the use of laparoscopy for the treatment of ARMs especially those where the fistula is below the peritoneal reflection. Once detected, the diverticulum should be excised.
authors.affiliation: Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. shumyle.alam@cchmc.org
authors.forename: Shumyle
authors.initials: S
authors.lastname: Alam
authors.forename: Taiwo A
authors.initials: TA
authors.lastname: Lawal
authors.forename: Alberto
authors.initials: A
authors.lastname: Peña
authors.forename: Curtis
authors.initials: C
authors.lastname: Sheldon
authors.forename: Marc A
authors.initials: MA
authors.lastname: Levitt
mesh_terms: D000293:Adolescent; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003558:Cystoscopy / Q000379:methods; D004240:Diverticulum / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D014567:Urography / Q000379:methods; D055815:Young Adult