title: The transpubic approach for the correction of complex anorectal and urogenital malformations.
abstract: BACKGROUND
  The transpubic approach has been used mainly to treat urethral injuries and prostate cancer. There are no reports describing this approach in anorectal malformations.
  
  
  METHODS
  Forty-two patients who underwent a transpubic approach for their genitourinary/colorectal reconstruction were reviewed. Indications, complications, and follow-up were analyzed. A midline infraumbilical incision was used. The pubic cartilage was divided with needle cautery. Institutional review board approval was obtained (IRB# 2008-1317).
  
  
  RESULTS
  The cases included complex malformations (16), covered exstrophy (15), long urogenital sinus with normal rectum (6), and reoperations in cloacas which had been left with persistent fistulae between vagina and urinary tract with normal rectum (5). Excellent exposure was achieved in all cases, allowing successful anatomical reconstruction. Functional results varied depending on the specific type of defect but were not expected to be good due to severe congenital or acquired anatomic defects. There were 3 complications related to the transpubic approach: pubic dehiscence, suspected osteomyelitis, and bleeding.
  
  
  CONCLUSIONS
  The transpubic approach should be considered for the repair of complex anorectal and urogenital malformations, especially when adequate exposure cannot be achieved with an abdominal, perineal, or posterior sagittal approach. Another ideal indication is in patients with a normal rectum who were born with a complex urogenital sinus or underwent a failed attempted repair but were left with problems requiring reoperation in a scarred and fibrotic pelvis.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. alberto.pena@cchmc.org
authors.forename: Alberto
authors.initials: A
authors.lastname: Peña
authors.forename: Andrea
authors.initials: A
authors.lastname: Bischoff
authors.forename: Marc A
authors.initials: MA
authors.lastname: Levitt
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery; D001746:Bladder Exstrophy / Q000601:surgery; D002358:Cartilage, Articular / Q000601:surgery; D002988:Cloaca / Q000601:surgery; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010019:Osteomyelitis / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011631:Pubic Symphysis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013536:Suture Techniques; D014548:Urinary Fistula / Q000601:surgery; D014564:Urogenital Abnormalities / Q000601:surgery*; D014624:Vaginal Fistula / Q000601:surgery