title: Management of female anterior perineal injuries with urethrovaginal disruption by anterior sagittal transanorectal approach.
abstract: OBJECTIVE
  Urethrovaginal disruption injury poses a considerable challenge in surgical correction, mainly due to difficult access to the receded urethrovaginal unit deep in the scarred anterior perineum. We assessed the feasibility, safety and efficacy of the anterior sagittal transanorectal approach (ASTRA) in the repair of anterior perineal injury with urethrovaginal disruption in female children.
  
  
  METHODS
  Three girls with urethrovaginal disruption following perineal injury were operated by ASTRA between March 2008 and December 2010. All of them had severe scarring of the anterior perineum at the time of definitive repair by this approach. One underwent ASTRA repair without a covering colostomy.
  
  
  RESULTS
  Total urethrovaginal mobilization and anchorage of urethral and vaginal orifices at the vestibule were successfully achieved in all patients. One patient has developed vaginal stenosis at 1.5 years follow up. Despite the absence of a colostomy cover in one case, there were no wound complications in the early postoperative period.
  
  
  CONCLUSIONS
  The ASTRA is safe and efficacious in the repair of traumatic urethrovaginal disruption in children.
authors.affiliation: Department of Pediatric Surgery, Vardhman Mahavir Medical College & Safdarjang Hospital, New Delhi, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Bagga
authors.forename: Narinder
authors.initials: N
authors.lastname: Teckchandani
authors.forename: Devendra K
authors.initials: DK
authors.lastname: Yadav
authors.forename: Samir Kant
authors.initials: SK
authors.lastname: Acharya
authors.forename: Bikash
authors.initials: B
authors.lastname: Nareti
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D010502:Perineum / Q000293:injuries* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012421:Rupture / Q000601:surgery; D012494:Sampling Studies; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000293:injuries* / Q000601:surgery; D013519:Urogenital Surgical Procedures / Q000379:methods*; D014621:Vagina / Q000293:injuries* / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000601:surgery*