Acquired posterior urethral diverticulum following surgery for anorectal malformations Shumyle Alam a, ⁎ , Taiwo A. Lawal b , Alberto Peña b , Curtis Sheldon a , Marc A. Levitt b a Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA b Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA Received 19 March 2011; accepted 26 March 2011 Key words: Anorectal malformation; Posterior urethral diverticulum; Complications Abstract Purpose: 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. Conclusion: 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. © 2011 Elsevier Inc. All rights reserved. Despite significant advances in the surgical management of anorectal malformations (ARMs), many children still experience significant debilities from potentially avoidable complications with urologic sequelae [1,2]. The most common urologic complications occurring with the surgical management of ARMs are rectourinary fistulas (23.3%), bladder injuries (22.5%), urethral injuries (20.2%), posterior urethral diverticula (17.8%), injuries to the external genitalia (14%), and ureteral injuries (0.8%) [1]. Urethral diverticulum in males without ARM may be congenital in origin [3-5] or may occur following trauma, urethral stricture, or prior urethroplasty [5,6]. Failure to mobilize the distal rectum adequately and creating a too distally located colostomy have been noted to contribute to the occurrence of urologic complications in ARMs [2]. In addition, a suboptimally done high-pressure distal colostogram may contribute to errors in diagnosis and nonrecognition of rectourethral fistulas [2]. Ligating the rectal stump at some distance from the urethra increases the ⁎ Corresponding author. Tel.: +1 513 636 2589; fax: +1 513 636 6753. E-mail address: shumyle.alam@cchmc.org (S. Alam). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2011.03.061 Journal of Pediatric Surgery (2011) 46, 1231–1235