In neonates with an imperforate anus associated with a rectovesical fistula, the rectum communicates with the neck of the bladder. The perineum appears flat to inspection. The underlying sphincter and sacrum are commonly under- or maldeveloped, so diminishing the prognosis.
A descending colostomy is fashioned before a posterior sagittal anorectoplasty (PSARP) procedure is used for definitive correction. The supralevator nature of the conduit necessitates the concomitant use of a laparotomy to separation and mobilization of the rectum.
After surgery, voluntary bowel movements are only achieved by 20% of individuals by three years of age.
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