Letter to the Editor: Sphincter-Sparing Posterior Sagittal Anorectoplasty for Rectourethral Fistulas: A Potential Refinement to Consider?

The introduction of Posterior Sagittal Anorectoplasty (PSARP) by Peña and deVries has undeniably revolutionized the management of anorectal malformations (ARMs) [1]. The technique's emphasis on complete visualization and meticulous fistula management has significantly improved outcomes, establishing it as a cornerstone in ARMs surgery. However, despite these advancements, fecal incontinence and soiling remain challenging complications, with complete fecal continence achieved in only 24 % of patients in the most recent and largest multi-institutional study [2].