A Complex Urogenital Malformation: Urogenital Sinus with Normal Anus

The most common type of urogenital sinus has a long urethra and a short common channel

For urogenital sinus with long urethra and short common channel, a transperineal total urogenital mobilization is appropriate

An astra approach involves incising the anterior wall of the rectum to gain more exposure

A trans anorectal approach can be performed with extension to include the posterior sagittal incision

For urogenital sinus with normal anus, there are two surgical options: total urogenital mobilization for short common channel and long urethra, and urogenital separation for long common channel and short urethra

Cystoscopy revealed a long common channel and a short urethra in this case

When there is a long common channel and short urethra, the surgical plan is to separate the vagina from the common channel and allow the common channel plus the native urethra to become the neourethra

The patient is placed prone for the trans anorectal approach

The anal canal is marked with silk sutures to facilitate its reconstruction after it has been split

The trans anorectal approach is an extension of the astra concept, which is incision of the anterior anus only

The vaginal-common channel fistula is identified after opening the vagina in the midline

Silk sutures are used to help mobilize the anterior wall of the vagina off of the urinary tract anterior to it

The posterior urethra is repaired in two layers

An ischiorectal fat pad is used to cover the posterior urethral repair

The vagina is mobilized so that it comfortably reaches the introitus

The vagina is sutured first to the posterior urethral meatus before completing the introitoplasty