The treatment of a urogenital sinus with normal rectum and a high implanted vagina, represents a challenge. For this particular malformation, a transanorectal approach has been designed. The pelvis is approached through a midline sagittal incision, dividing the posterior and anterior rectal wall as well as the sphincteric mechanism. The rectum is bivalved in the midline. The vagina is then separated from the urogenital sinus and mobilized down to the perineum. The rectum and sphincteric mechanism are meticulously reconstructed. Results have been good for bowel and urinary control in four cases.