# Pediatric Colorectal and Pelvic Reconstruction — GCMD Library living collection

Updated: n/a · 15 episodes · 113 cited statements

## Episodes
### Featured
- [Lasting impact on children with an anorectal malformations with proper surgical preparation, respect for anatomic principles, and precise surgical management](https://library.globalcastmd.com/watch/lasting-impact-on-children-with-an-anorectal-malformations-with-proper-surgical-preparation-respect-for-anatomic-principles-and-precise-surgical-management-3280) — article · [machine version](https://library.globalcastmd.com/watch/lasting-impact-on-children-with-an-anorectal-malformations-with-proper-surgical-preparation-respect-for-anatomic-principles-and-precise-surgical-management-3280.md)
- [Colorectal Quiz Episode 15: Bowel Management in Spinal Patients - Need for a UrologistPart 1](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232) — podcast · 17:26 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232.md)
- [Colorectal Quiz Episode 16: Bowel Management in Spinal Patients - Need for a Urologist Part 2](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304) — podcast · 14:18 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304.md)
- [Update Course Rewind: 2021 Top Ten Key Takeaways](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578) — video · 16:02 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578.md)
- [Update Course Rewind: Pediatric Colorectal Consortium 2021](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357) — podcast · 14:55 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357.md)
- [Update Course 2021: PEDS COLORECTAL CONSORTIUM CONCLUSIONS](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413) — video · 36:32 · [machine version](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413.md)
- [Does presence of a VACTERL anomaly predict an associated gynecologic anomaly in females with anorectal malformations?](https://library.globalcastmd.com/watch/does-presence-of-a-vacterl-anomaly-predict-an-associated-gynecologic-anomaly-in-females-with-anorectal-malformations-6574) — article · [machine version](https://library.globalcastmd.com/watch/does-presence-of-a-vacterl-anomaly-predict-an-associated-gynecologic-anomaly-in-females-with-anorectal-malformations-6574.md)
- [¿La presencia de VACTERL predice anomalías ginecológicas en pacientes femeninas con malformación anorectal (MAR)?](https://library.globalcastmd.com/watch/la-presencia-de-vacterl-predice-anomal-as-ginecol-gicas-en-pacientes-femeninas-con-malformaci-n-anorectal-6575) — article · [machine version](https://library.globalcastmd.com/watch/la-presencia-de-vacterl-predice-anomal-as-ginecol-gicas-en-pacientes-femeninas-con-malformaci-n-anorectal-6575.md)
- [Hirschsprung-associated inflammatory bowel disease](https://library.globalcastmd.com/watch/hirschsprung-associated-inflammatory-bowel-disease-6707) — video · [machine version](https://library.globalcastmd.com/watch/hirschsprung-associated-inflammatory-bowel-disease-6707.md)
- [Enfermedad Inflamatoria intestinal asociada a Hirschsprung](https://library.globalcastmd.com/watch/enfermedad-inflamatoria-intestinal-asociada-a-hirschsprung-6708) — video · 0:58 · [machine version](https://library.globalcastmd.com/watch/enfermedad-inflamatoria-intestinal-asociada-a-hirschsprung-6708.md)
- [Hirschsprung-associated inflammatory bowel disease: A multicenter study from the APSA Hirschsprung disease interest group](https://library.globalcastmd.com/watch/hirschsprung-associated-inflammatory-bowel-disease-a-multicenter-study-from-the-apsa-hirschsprung-disease-interest-group-6800) — article · [machine version](https://library.globalcastmd.com/watch/hirschsprung-associated-inflammatory-bowel-disease-a-multicenter-study-from-the-apsa-hirschsprung-disease-interest-group-6800.md)
- [Colorectal Quiz Episode 16: Bowel Management in Spinal Patients - Need for a Urologist Part 2](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851) — video · 14:18 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851.md)
- [Colorectal Quiz Episode 15: Bowel Management in Spinal Patients - Need for a UrologistPart 1](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887) — video · 17:26 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887.md)
- [Does Delayed Diagnosis of Hirschsprung Disease Impact Post-operative and Functional Outcomes?](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-9022) — article · [machine version](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-9022.md)
- [Does Delayed Diagnosis of Hirschsprung Disease Impact Post-operative and Functional Outcomes? A Multi-Center Review From the Pediatric Colorectal and Pelvic Learning Consortium](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263) — video · 1:09 · [machine version](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=0) Introduction and case presentation setup (Ep 2)
- [2:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=130) Initial presentation: 5-month-old with myelomeningocele and constipation (Ep 2)
- [4:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=250) Management of senna-induced rash and alternative laxative strategies (Ep 2)
- [6:12](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=372) Transition to enema-based bowel management (Ep 2)
- [9:33](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=573) Surgical planning: Malone procedure and coordination with urology (Ep 2)
- [11:08](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=668) Temporizing measures when urologic plan is uncertain (Ep 2)
- [15:53](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=953) Case summary and key takeaways (Ep 2)
- [0:04](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=4) Introduction and recap of part one (Ep 3)
- [1:09](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=69) Appendix sharing and channel lengthening techniques (Ep 3)
- [4:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=278) Ambulatory status and surgical planning considerations (Ep 3)
- [7:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=459) Orifice placement and operative sequencing (Ep 3)
- [11:09](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=669) Enema techniques for poor pelvic floor tone (Ep 3)
- [0:12](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=12) Takeaway #10: Medical Management of Uncomplicated Appendicitis (Ep 4)
- [1:45](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=105) Takeaway #9: Surgical Approach to Osteosarcoma Lung Metastases (Ep 4)
- [3:08](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=188) Takeaway #8: Flourish Device for Esophageal Atresia (Ep 4)
- [4:43](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=283) Takeaway #7: Indocyanine Green Applications in Pediatric Surgery (Ep 4)
- [6:06](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=366) Takeaway #6: Timing of Colorectal Procedures (Ep 4)
- [7:42](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=462) Takeaway #5: Pain Management for Pectus Repair (Ep 4)
- [9:29](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=569) Takeaway #4: Button Battery Ingestion Management (Ep 4)
- [11:12](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=672) Takeaway #3: Updated ATLS Guidelines for Pediatric Hemorrhagic Shock (Ep 4)
- [12:21](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=741) Takeaway #2: Management of Primary Spontaneous Pneumothorax (Ep 4)
- [13:49](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=829) Takeaway #1: Diversity, Equity, and Inclusion in Pediatric Surgery (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=0) Anal Dilations After PSARP: Evidence for Abandonment (Ep 5)
- [4:14](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=254) Timing of Repair for Low Anorectal Malformations (Ep 5)
- [6:57](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=417) Hirschsprung Disease: Long Segment Management and Timing (Ep 5)
- [9:48](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=588) Bowel Management in Anorectal Malformations (Ep 5)
- [11:35](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=695) Timing of Pull-Through for Hirschsprung Disease and Health Disparities (Ep 5)
- [12:58](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=778) Cloacal Reconstruction: Anatomic Considerations (Ep 5)
- [0:05](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=5) Anal Dilations Following PSARP: Evidence for Abandoning Routine Protocol (Ep 6)
- [7:16](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=436) Introduction to the Pediatric Colorectal and Pelvic Learning Consortium (Ep 6)
- [12:11](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=731) Timing of Repair for Low Anorectal Malformations: Early Versus Delayed (Ep 6)
- [21:01](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1261) Total Colonic Hirschsprung Disease: Earlier Pull-Through with Ileostomy Management (Ep 6)
- [26:42](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1602) Bowel Management in Anorectal Malformation Patients (Ep 6)
- [29:55](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1795) Timing of Pull-Through for Rectosigmoid Hirschsprung Disease (Ep 6)
- [31:48](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1908) Disparities in Continence Outcomes for Anorectal Malformation Patients (Ep 6)
- [33:33](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=2013) Cloacal Reconstruction: Moving Beyond the 3-Centimeter Rule (Ep 6)
- [0:04](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=4) Introduction and recap of part one (Ep 12)
- [1:09](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=69) Appendix-sharing techniques and channel lengthening (Ep 12)
- [4:42](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=282) Ambulatory status and bowel management choice (Ep 12)
- [7:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=459) Surgical planning for combined procedures (Ep 12)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- The Pediatric Colorectal and Pelvic Learning Consortium conducted a multi-center retrospective review from 2017 to 2023 examining the relationship between delayed diagnosis of Hirschsprung disease and postoperative/functional outcomes. — Alex Halpern (clinical) [Ep 15 · 0:12](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=12)
- The study included 679 patients with Hirschsprung disease from 14 different sites. — Alex Halpern (epidemiological) [Ep 15 · 0:23](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=23)
- Increased age at diagnosis was associated with a greater likelihood of undergoing fecal diversion after initial pull-through procedure. — Alex Halpern (clinical) [Ep 15 · 0:29](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=29)
- Increased age at diagnosis was associated with an increased risk of constipation or incontinence requiring intervention postoperatively. — Alex Halpern (clinical) [Ep 15 · 0:39](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=39)
- No association was found between age at diagnosis and 30-day complication rate after initial pull-through. — Alex Halpern (clinical) [Ep 15 · 0:49](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=49)
- No association was found between age at diagnosis and need for pull-through revision. — Alex Halpern (clinical) [Ep 15 · 0:49](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=49)
- Delayed diagnosis of Hirschsprung disease affects certain postoperative and functional outcomes in patients. — Alex Halpern (clinical) [Ep 15 · 0:58](https://library.globalcastmd.com/watch/does-delayed-diagnosis-of-hirschsprung-disease-impact-post-operative-and-functional-outcomes-a-multi-center-review-from-the-pediatric-colorectal-and-pelvic-learning-consortium-9263?t=58)
- MiraLax softens stool but does not provide a 'push' to expel it, which can leave the colon full of soft stool. — Christine Warner (clinical) [Ep 2 · 6:16](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=376)
- Senna and bisacodyl are the two medications that provide a 'kick' or push for stool expulsion; everything else is a stool softener. — Marc Levitt (clinical) [Ep 2 · 6:59](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=419)
- MiraLax is problematic for patients with anorectal malformations who need fullness to detect stool, because it makes soft stool that 'mushes out' without discrete sensation. — Marc Levitt (clinical) [Ep 2 · 7:15](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=435)
- Senna-induced perineal rash is thought to be a chemical burn rather than a true allergy, presenting with blistering. — Jason Frischer (clinical) [Ep 2 · 5:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=330)
- Senna rash is treated with silver sulfadiazine and resolves with time; some patients tolerate senna upon reintroduction. — Jason Frischer (clinical) [Ep 2 · 5:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=338)
- Timing senna doses in the early morning so that bowel movements occur during the day (when diapers are changed promptly) reduces the risk of senna rash. — Jason Frischer (clinical) [Ep 2 · 5:47](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=347)
- Glycerin is generally better tolerated than castile soap for enemas in children; castile soap commonly causes cramping and discomfort. — Wendy Lewis (clinical) [Ep 2 · 9:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=550)
- A Malone appendicostomy provides tube-free access for antegrade enemas via daily catheterization of the channel. — Rebecca Rentea (clinical) [Ep 2 · 9:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=579)
- Children with spinal differences may need bladder access later in life, and the appendix is the preferred conduit for a Mitrofanoff urinary channel. — Rebecca Rentea (clinical) [Ep 2 · 9:49](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=589)
- Coordination with urology from the beginning of bowel management planning is essential in spinal patients to preserve the appendix for potential urologic reconstruction. — Marc Levitt (clinical) [Ep 2 · 10:02](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=602)
- A cecostomy tube (placed laparoscopically or by interventional radiology) provides direct access to the cecum for antegrade enemas and preserves the appendix for future reconstruction. — Rebecca Rentea (clinical) [Ep 2 · 11:53](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=713)
- A non-plicating, non-trimmed Malone appendicostomy (tip of appendix sewn to right lower quadrant with a balloon tube, without plication or trimming) preserves the appendix for potential future urologic use or splitting. — Marc Levitt (clinical) [Ep 2 · 12:22](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=742)
- Urologists prefer an appendix of at least 5 cm length for a Mitrofanoff; shorter appendices are not suitable for urologic use. — Marc Levitt (clinical) [Ep 2 · 13:36](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=816)
- An appendix of 2 cm is too short for either colorectal or urologic use; 5 cm goes to urology; 7 cm may be splittable (2 cm for colorectal, 5 cm for urology); longer appendices are certainly splittable. — Marc Levitt (clinical) [Ep 2 · 13:16](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=796)
- For urologic reconstruction, the appendix is preferred over a Monti channel made from small bowel for long-term outcomes. — Marc Levitt (clinical) [Ep 2 · 14:07](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=847)
- A neo-Malone can be created from a flap of colon if the appendix is used for urologic purposes. — Marc Levitt (clinical) [Ep 2 · 14:18](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=858)
- Taking down a cecostomy tube is relatively easy and leaves the appendix free for subsequent use. — Marc Levitt (clinical) [Ep 2 · 15:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=938)
- Bisacodyl can be administered as an enema or suppository in infants. — Jason Frischer (clinical) [Ep 2 · 8:31](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=511)
- When a 7 cm appendix is shared between urology and colorectal surgery, the urologist typically takes 6.25 cm leaving only 0.75 cm for colorectal use — Jason Frischer (clinical) [Ep 3 · 1:17](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=77)
- Urologists typically take a 70/30 split when sharing the appendix — Marc Levitt (opinion) [Ep 3 · 1:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=98)
- The colorectal team benefits from using the appendix portion closer to the cecum which has a stronger blood supply — Jason Frischer (clinical) [Ep 3 · 1:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=115)
- A short appendiceal stump can be extended by suturing or using a laparoscopic non-cutting linear stapler along the cecal wall to add 2-3 cm of length — Jason Frischer (clinical) [Ep 3 · 2:05](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=125)
- One of the problems with Malone appendicostomy is leakage — Jason Frischer (clinical) [Ep 3 · 2:34](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=154)
- The longer the Malone channel, the less likely it is to leak — Jason Frischer (clinical) [Ep 3 · 2:47](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=167)
- Extending the Malone channel by 2-3 cm using suturing or stapling can be extremely helpful in preventing leakage — Jason Frischer (clinical) [Ep 3 · 2:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=175)
- Children in rural locations or with behavioral issues who pull at tubes are good candidates for an unplicated Malone (clinical) [Ep 3 · 3:02](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=182)
- Rectal irrigation using pressurized water systems made for patients with hand difficulties is an alternative to Malone and Mitrofanoff procedures — Jason Frischer (clinical) [Ep 3 · 3:43](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=223)
- Coloplast makes a rectal irrigation device for self-administration of enemas — Jason Frischer (clinical) [Ep 3 · 4:25](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=265)
- Spinal patients with absent coccyx have difficulty retaining rectal enema fluid even for the short time from standing to reaching the toilet — Wendy (clinical) [Ep 3 · 4:57](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=297)
- Cecostomy or Malone routes allow spinal patients with mobility compromise to use a small floor potty rather than transferring to a toilet — Wendy (clinical) [Ep 3 · 5:23](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=323)
- Most spinal patients prefer not to have a stoma bag and prefer transferring to a commode for antegrade flush — Marc Levitt (clinical) [Ep 3 · 5:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=345)
- If the colon is very difficult to empty (requiring voluminous or concentrated enemas) and the urologist needs to do bladder augmentation, the sigmoid can be removed from colonic transit to make bowel management easier and used by the urologist for augmentation — Marc Levitt (clinical) [Ep 3 · 6:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=398)
- If the patient has an easy to empty colon, the colon can stay in and the urologist can use small bowel for augmentation — Marc Levitt (clinical) [Ep 3 · 7:24](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=444)
- A good bowel management plan can influence the urologic surgical plan — Marc Levitt (clinical) [Ep 3 · 7:52](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=472)
- Once patients are emptying regularly for stool without impactions, their bladder may work better and reflux might resolve — Marc Levitt (clinical) [Ep 3 · 7:58](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=478)
- Successful bowel management might save a patient from needing ureteral reimplantation — Marc Levitt (clinical) [Ep 3 · 8:09](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=489)
- Urologists often request that bowel management work happen first before determining what bladder surgery is needed — Marc Levitt (clinical) [Ep 3 · 8:15](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=495)
- In Kansas City, the Mitrofanoff goes at the umbilicus and the MACE or appendicostomy goes in the right lower quadrant (clinical) [Ep 3 · 9:19](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=559)
- Anatomically, the bladder is a midline structure and access through the umbilicus makes sense, while the cecum is in the right lower quadrant — Marc Levitt (clinical) [Ep 3 · 9:29](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=569)
- At Cincinnati Children's, 99% of Malones are placed in the umbilicus and almost all Mitrofanoffs are in the right lower quadrant with a tunnel channel through the rectus to prevent leakage — Jason Frischer (clinical) [Ep 3 · 9:43](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=583)
- The primary determinant of orifice location is where the appendix reaches and its blood supply — Jason Frischer (clinical) [Ep 3 · 10:21](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=621)
- Orifices should be properly separated and not matured until all teams have completed their work to avoid pulling on each other's mesentery — Marc Levitt (clinical) [Ep 3 · 10:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=639)
- Laxity of the pelvic floor and anal canal is a huge issue in spinal patients, especially when doing retrograde enemas — Jason Frischer (clinical) [Ep 3 · 11:09](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=669)
- Adding bisacodyl to the flush has shown good success in spinal patients — Wendy (clinical) [Ep 3 · 11:31](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=691)
- Spinal patients sometimes do better with smaller flush volumes because their colons empty at different rates — Wendy (clinical) [Ep 3 · 11:35](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=695)
- Putting additional water volume into the enema balloon helps hold it in place so fluid doesn't leak around it in patients who cannot hold the enema like other children (clinical) [Ep 3 · 12:16](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=736)
- Dr. Rentia currently sizes the anus at 2 weeks and 1 month in practice to understand the diameter of the anoplasty so that stooling is not obstructed by an unrecognized strictured anoplasty. — Rebecca Rentea (opinion) [Ep 5 · 3:19](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=199)
- Dr. Rentia would only consider initiating full dilations for slightly older children where dilations are more traumatic and if concerned about needing general anesthesia, given that HM anoplasty is an option. — Rebecca Rentea (opinion) [Ep 5 · 3:38](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=218)
- About 5 to 8% of patients require a strictureplasty at the two-month period. — Rebecca Rentea (epidemiological) [Ep 5 · 4:04](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=244)
- Dr. Rentia is a fan of doing dilations in the neonatal period for low malformations and having the family discharged as soon as possible to home. — Rebecca Rentea (opinion) [Ep 5 · 5:03](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=303)
- Dr. Smith finds that for neonates and infants up to several months old, dilations are really well tolerated, but avoids them in older age groups. — Caitlin Smith (opinion) [Ep 5 · 6:22](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=382)
- Formula-fed infants who need caloric concentration have thicker stools, which might push toward earlier repair, while breastfed infants can delay until 2-3 months. — Caitlin Smith (clinical) [Ep 5 · 6:32](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=392)
- Repair should be done before infants start solids because that makes the dilation strategy at home much more difficult. — Caitlin Smith (clinical) [Ep 5 · 6:47](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=407)
- Dr. Rentia performs pull-through when the child is toilet trained for urine, typically at age 4, because waiting too long can result in horrible anal sphincter spasm and pelvic disease that makes keeping a pull-through challenging. — Rebecca Rentea (opinion) [Ep 5 · 9:25](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=565)
- Dr. Smith wonders if the PCPLC, being made up of specialty centers, may miss some race and ethnic disparities since patients who can afford to travel to these centers may be captured while those without means are not. — Caitlin Smith (opinion) [Ep 5 · 12:40](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=760)
- The Heineke-Mikulicz anoplasty should be performed at the skin level; long strictures extending through the sphincter complex are not suitable for this technique. — Rebecca Rentea (clinical) [Ep 6 · 9:35](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=575)
- Current practice shows approximately 5-8% of patients require strictureplasty at the two-month follow-up period when dilations are not routinely performed. — Rebecca Rentea (clinical) [Ep 6 · 10:25](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=625)
- The Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) is a multi-institutional consortium across the United States comprised of 17 institutions including free-standing children's hospitals. — Rebecca Rentea (clinical) [Ep 6 · 11:07](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=667)
- Neonates and infants under about 3 months of age tolerate anal dilations well, but for older patients dilations become a greater psychological stressor for parents and patients. — Caitlin Smith (opinion) [Ep 6 · 17:39](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1059)
- The optimal timing for repair of low anorectal malformations is around 2-3 months, balancing the goal of keeping the fistula open without trying to increase size, while managing constipation with MiraLax to keep stool soft. — Rebecca Rentea (opinion) [Ep 6 · 18:17](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1097)
- Formula-fed infants requiring caloric concentration have thicker stools and may need earlier repair, while breastfed infants can safely wait until 2-3 months; repair should be completed before starting solid foods. — Caitlin Smith (clinical) [Ep 6 · 18:54](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1134)
- Water-soluble fiber and Imodium can be used to thicken and slow ileostomy effluent before pull-through in total colonic Hirschsprung patients. — Rebecca Rentea (clinical) [Ep 6 · 25:32](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1532)
- Delaying pull-through too long in total colonic Hirschsprung can result in horrible anal sphincter spasm and pelvic disease that makes maintaining a pull-through challenging. — Rebecca Rentea (clinical) [Ep 6 · 26:23](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1583)
- Delayed pull-through with rectal irrigations and sending the family home is a safe alternative to neonatal operation for Hirschsprung disease when there is adequate family support. — Rebecca Rentea (clinical) [Ep 6 · 31:12](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1872)
- When appendix is split between urology and colorectal teams, urologists typically take approximately 70% and colorectal takes 30% — Marc Levitt (clinical) [Ep 12 · 1:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=98)
- The colorectal team benefits from using the appendix portion closer to the cecum because it has a stronger blood supply — Jason Frischer (clinical) [Ep 12 · 1:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=115)
- A 1-2 centimeter appendiceal stump can be extended 2-3 more centimeters by suturing or using a non-cutting laparoscopic linear stapler along the cecal wall — Jason Frischer (clinical) [Ep 12 · 2:05](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=125)
- One of the problems with Malone procedures is leakage — Jason Frischer (clinical) [Ep 12 · 2:34](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=154)
- The longer the Malone channel, the less likely it is to leak — Jason Frischer (clinical) [Ep 12 · 2:47](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=167)
- Extending the Malone channel 2-3 centimeters by suturing or stapling can be extremely helpful in preventing leakage — Jason Frischer (clinical) [Ep 12 · 2:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=175)
- Children in rural locations who are behavioral and pull at tubes are good candidates for unplicated Malone procedures (clinical) [Ep 12 · 3:02](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=182)
- Rectal irrigation devices made by companies like Coloplast are available for patients with hand difficulties to self-administer enemas using pressurized water systems — Jason Frischer (clinical) [Ep 12 · 3:57](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=237)
- Spinal patients with absent coccyx have difficulty retaining enema fluid even for the short time from standing up to getting on the toilet (clinical) [Ep 12 · 4:57](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=297)
- Most spinal patients prefer not to have a bag and would prefer transferring to a commode and doing an antegrade flush — Marc Levitt (opinion) [Ep 12 · 5:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=345)
- If the colon is very difficult to empty (requiring voluminous or concentrated enemas) and the urologist needs to do bladder augmentation, the sigmoid can be removed from colonic transit to make bowel management easier and used for the augmentation — Marc Levitt (clinical) [Ep 12 · 6:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=398)
- If the patient has an easy to empty colon and needs bladder augmentation, the urologist can use small bowel instead — Marc Levitt (clinical) [Ep 12 · 7:20](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=440)
- A good bowel management plan can influence the urologic plan; patients who are empty regularly for stool and never have impactions may have improved bladder function — Marc Levitt (clinical) [Ep 12 · 7:52](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=472)
- Successful bowel management might cause reflux to resolve and save a patient from ureter reimplantation — Marc Levitt (clinical) [Ep 12 · 8:07](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=487)
- In Kansas City, the Mitrofanoff goes at the umbilicus and the MACE or appendicostomy goes in the right lower quadrant (clinical) [Ep 12 · 9:19](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=559)
- Anatomically, the bladder is a midline structure and access through the umbilicus makes sense; the cecum is in the right lower quadrant so placing it there makes sense — Marc Levitt (clinical) [Ep 12 · 9:27](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=567)
- At Cincinnati Children's, 99% of Malones are in the umbilicus with a few in the right lower quadrant, and almost all Mitrofanoffs are in the right lower quadrant with a tunnel channel through the rectus to prevent leakage — Jason Frischer (clinical) [Ep 12 · 9:43](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=583)
- The number one driving point for orifice placement is where the appendix reaches and the blood supply — Jason Frischer (clinical) [Ep 12 · 10:21](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=621)
- Orifices should be properly separated and not matured until everyone has a plan in the OR, so one team is not pulling on the other's mesentery — Marc Levitt (clinical) [Ep 12 · 10:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=639)
- The laxity of pelvic floor and anal canal in spinal patients is a huge issue that makes them different, especially when doing retrograde enemas — Jason Frischer (clinical) [Ep 12 · 11:09](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=669)
- Adding bisacodyl to the flush has shown really good success in spinal patients (clinical) [Ep 12 · 11:31](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=691)
- Spinal patients sometimes do better with smaller enema volumes because their colons dump out at different rates (clinical) [Ep 12 · 11:35](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=695)
- For enemas through the rectum, putting additional water volume into the balloon helps hold it in place so fluid doesn't go around it, because spinal patients don't have the ability to hold like other kids (clinical) [Ep 12 · 12:16](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=736)
- MiraLax softens stool but does not provide enough push to achieve a full clean-out — Christine Warner (clinical) [Ep 13 · 6:16](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=376)
- Senna and bisacodyl are the two medications that have a 'kick' (stimulant effect); everything else is a stool softener — Marc Levitt (clinical) [Ep 13 · 6:59](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=419)
- Softening stool with MiraLax makes it mushy and flowing but leaves the colon full, which is problematic for patients who need fullness to detect stool (particularly anorectal malformations) — Marc Levitt (clinical) [Ep 13 · 7:15](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=435)
- Senna-induced perineal rash appears to be a chemical burn rather than an allergic reaction, presenting with blistering — Jason Frischer (clinical) [Ep 13 · 5:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=330)
- Senna rash is treated with silver sulfadiazine and resolves with time; some patients tolerate Senna reintroduction after recovery — Jason Frischer (clinical) [Ep 13 · 5:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=338)
- Senna rash has been observed with all three formulations (tablet, liquid, chocolate squares) — Jason Frischer (clinical) [Ep 13 · 5:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=330)
- Timing Senna dose to early morning so bowel movements occur during the day with frequent diaper changes reduces risk of Senna rash compared to overnight dosing — Jason Frischer (clinical) [Ep 13 · 5:53](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=353)
- Glycerin is better tolerated than castile soap in pediatric enemas; children complain of cramping and discomfort with castile — Wendy Lewis (clinical) [Ep 13 · 9:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=550)
- A Malone procedure allows future catheterization of the channel once daily with no tubes in the belly — Rebecca Rentea (clinical) [Ep 13 · 9:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=579)
- Children with spinal differences may need bladder access later in life, and the ideal channel for this would be from the appendix (Mitrofanoff) — Rebecca Rentea (clinical) [Ep 13 · 9:49](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=589)
- Cecostomy is a direct access tube placed from the abdominal wall into the cecum (analogous to a G-tube for the colon) and preserves the appendix for future reconstructive needs — Rebecca Rentea (clinical) [Ep 13 · 11:53](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=713)
- A non-plicated Malone using the tip of the appendix sewn to the right lower quadrant preserves the option to split the appendix later for urologic reconstruction or to use it for Mitrofanoff — Marc Levitt (clinical) [Ep 13 · 12:22](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=742)
- When performing a non-plicated Malone as a temporizing measure, do not trim the appendix to preserve maximum length — Rebecca Rentea (clinical) [Ep 13 · 12:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=775)
- Urologists require a 5 cm appendix for Mitrofanoff; anything shorter is not useful for urology and can be used for Malone — Marc Levitt (clinical) [Ep 13 · 13:36](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=816)
- A 7 cm appendix might be splitable (2 cm for Malone + 5 cm for Mitrofanoff); anything longer is certainly splitable — Marc Levitt (clinical) [Ep 13 · 13:59](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=839)
- For Mitrofanoff, the appendix is better long-term than a Monti channel made from small bowel — Marc Levitt (clinical) [Ep 13 · 14:07](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=847)
- A neo-Malone can be created using a flap of colon when the appendix is reserved for urologic use — Marc Levitt (clinical) [Ep 13 · 14:18](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=858)
- Taking down a cecostomy is relatively easy and leaves the appendix free for subsequent use — Marc Levitt (clinical) [Ep 13 · 15:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=938)
- In spinal patients approaching the age for urinary and stool continence, coordination with urology is essential before planning bowel management surgery — Marc Levitt (clinical) [Ep 13 · 10:02](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=602)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- About 5% of colorectal work is surgical and the rest is bowel management. — Rebecca Rentea summarizing the discussion [Ep 2 · 1:48](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=108)
- Senna rash may be related to the formulation (tablet, liquid, or chocolate squares) or to prolonged contact with stool, particularly overnight. — Marc Levitt summarizing the discussion [Ep 2 · 5:07](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=307)
- Careful assessment of existing bowel management including sit time, ingredients, and flush volume is necessary before the next surgical intervention — The host summarizing the discussion [Ep 3 · 7:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=459)
- Fecal impaction can push on the bladder and change the angle of the ureter entering the bladder, causing reflux — Jason Frischer summarizing the discussion [Ep 3 · 8:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=519)
- The last steps of combined procedures should be maturing the Mitrofanoff, maturing the Malone, then closing the abdomen — Jason Frischer summarizing the discussion [Ep 3 · 10:51](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=651)
- Having families or patients stand up at the end of their flush, move around, then sit back down helps evacuate more stool because things move through their colon differently — Wendy summarizing the discussion [Ep 3 · 11:54](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=714)
- In spinal patients with poor pelvic floor muscles, using additional water in the balloon, larger balloon size, or different shapes like a cone helps with enema administration — Amanda Jensen summarizing the discussion [Ep 3 · 12:48](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-4304?t=768)
- In the Petcova et al. study published in Annals of Surgery 2020, children with uncomplicated appendicitis were randomized to medical management with antibiotics or surgery, with 5-year follow-up. — Ellen Encisco summarizing the discussion [Ep 4 · 0:43](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=43)
- In the Petcova et al. appendicitis study, the surgery group had no complications, while 46% of patients in the non-surgical management group required appendectomy during follow-up. — The host summarizing the discussion [Ep 4 · 1:11](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=71)
- Medical management of acute uncomplicated appendicitis may be safe but is associated with a high failure rate, with many children ultimately requiring laparoscopic appendectomy. — Ellen Encisco summarizing the discussion [Ep 4 · 1:22](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=82)
- Metastectomy for osteosarcoma lung metastases improves survival and can make patients long-term survivors. — The host summarizing the discussion [Ep 4 · 2:15](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=135)
- Approximately 10% of 1 millimeter lung nodules in osteosarcoma patients contain malignant disease. — The host summarizing the discussion [Ep 4 · 2:24](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=144)
- The Children's Oncology Group is starting a study to determine whether thoracotomy or thoracoscopy is superior for resection of pulmonary metastases in osteosarcoma, with enrollment expected late 2021 or early 2022. — The host summarizing the discussion [Ep 4 · 2:40](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=160)
- The Flourish device is a catheter-based device that places magnets in proximal and distal esophageal pouches to create a compression anastomosis by causing ischemia of tissue between the magnets, which then sloughs off. — The host summarizing the discussion [Ep 4 · 3:16](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=196)
- Inclusion criteria for the Flourish device are: atretic gap less than 4 centimeters long, fistula repaired or absent, and G-tube able to accommodate an 18 French catheter. — The host summarizing the discussion [Ep 4 · 3:39](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=219)
- The Flourish device is associated with a high stricture rate and known serious life-threatening complications, and should only be used by centers with capabilities to treat the many issues associated with esophageal atresia. — The host summarizing the discussion [Ep 4 · 3:57](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=237)
- Indocyanine green (ICG) has become a topic of interest in the last few years for use in pediatric surgery, especially in minimally invasive procedures to improve visualization of structures. — Ellen Encisco summarizing the discussion [Ep 4 · 4:43](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=283)
- For laparoscopic cholecystectomy, ICG must be administered intravenously 12 to 18 hours prior to surgery to allow time for accumulation in the extrahepatic ducts, or can be injected directly into the gallbladder during surgery. — Ellen Encisco summarizing the discussion [Ep 4 · 5:32](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=332)
- ICG applications in pediatric surgery include laparoscopic cholecystectomies, varicocele repairs, partial nephrectomies, and tumor excisions. — Ellen Encisco summarizing the discussion [Ep 4 · 5:48](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=348)
- For anorectal malformations with rectal-perineal or rectal-vestibular fistula, outcomes including complications are similar whether the procedure is done before or after 14 days of life. — The host summarizing the discussion [Ep 4 · 6:37](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=397)
- A PCPLC consortium study comparing endorectal pull-through for Hirschsprung disease at less than 31 days versus greater than 31 days found that preoperative enterocolitis, postoperative enterocolitis, constipation, and incontinence were the same between both groups. — The host summarizing the discussion [Ep 4 · 6:54](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=414)
- Delayed pull-through with irrigations is a safe alternative to an operation in the neonatal period for Hirschsprung disease. — The host summarizing the discussion [Ep 4 · 7:14](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=434)
- Cryoanalgesia is probably effective at improving post-operative pain and decreasing length of stay for pectus patients, with length of stay reduced from 4 days to 1 day. — The host summarizing the discussion [Ep 4 · 8:11](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=491)
- There are no long-term studies on the effects of cryoanalgesia for pectus repair. — The host summarizing the discussion [Ep 4 · 8:34](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=514)
- The double rim sign or halo sign on X-ray indicates a child has swallowed a button battery rather than a coin. — Ellen Encisco summarizing the discussion [Ep 4 · 9:48](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=588)
- The main goal of button battery ingestion treatment is to remove the battery within 2 hours of ingestion. — Ellen Encisco summarizing the discussion [Ep 4 · 10:13](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=613)
- Sucralfate or honey can help reduce damage from button batteries on the child's esophagus as temporizing measures. — Ellen Encisco summarizing the discussion [Ep 4 · 10:20](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=620)
- Children less than 1 year old should not receive honey due to risk of botulism and should instead receive 10 mL of sucralfate every 10 minutes for up to 3 doses for button battery ingestion. — Ellen Encisco summarizing the discussion [Ep 4 · 10:35](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=635)
- Children over age 1 with button battery ingestion should receive honey 10 mL every 10 minutes for up to 6 doses. — Ellen Encisco summarizing the discussion [Ep 4 · 10:51](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=651)
- New ATLS recommendations for pediatric trauma patients in hemorrhagic shock call for earlier transfusion: after 1 bolus of 20 cc per kilogram of crystalloid fluid, blood should be given. — The host summarizing the discussion [Ep 4 · 11:28](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=688)
- Balanced transfusion protocol for pediatric hemorrhagic shock typically includes 10 to 20 mLs per kilogram of packed red blood cells, plus inclusion of FFP and platelets. — The host summarizing the discussion [Ep 4 · 11:38](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=698)
- Earlier transfusion in pediatric trauma was associated with shorter median time to transfusion and a decrease in total fluid volume administered. — The host summarizing the discussion [Ep 4 · 11:46](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=706)
- Whole blood in trauma patients requires less volume compared to component therapy. — The host summarizing the discussion [Ep 4 · 11:59](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=719)
- Research shows that observation of spontaneous pneumothorax in adults is non-inferior to immediate intervention with tube thoracostomy. — The host summarizing the discussion [Ep 4 · 12:42](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=762)
- The Midwest Pediatric Surgery Consortium study on spontaneous pneumothorax management with simple aspiration showed 48% success rate, but 44% of patients in the simple aspiration group recurred. — The host summarizing the discussion [Ep 4 · 12:53](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=773)
- 83% of patients who failed simple aspiration for spontaneous pneumothorax ultimately ended up with VATS or blebectomy. — The host summarizing the discussion [Ep 4 · 13:16](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=796)
- Greenwood et al. showed that mortality amongst black newborns is 3 times that of white newborns. — Ellen Encisco summarizing the discussion [Ep 4 · 14:10](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=850)
- When black newborns are treated by black physicians, their mortality is reduced by 58% compared to black newborns treated by white physicians. — Ellen Encisco summarizing the discussion [Ep 4 · 14:19](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=859)
- Bias exists within medicine and can change outcomes; representation matters and can make a difference. — Ellen Encisco summarizing the discussion [Ep 4 · 14:30](https://library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=870)
- A single institution prospective randomized controlled trial found that anal dilations after PSARP may not be needed. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 1:10](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=70)
- There is literature suggesting a component of psychosocial, psychological dissociation in children on later testing related to anal dilations. — Ellen Encisco summarizing the discussion [Ep 5 · 1:31](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=91)
- In the dilation study, length of follow-up was 12 months, PSARP had to be performed in a child under 24 months of age, it was primary surgery, and excluded cloaca as a diagnosis. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 1:37](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=97)
- The average PSARP was performed at 5 months in the study. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 1:50](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=110)
- A stricture was defined as a Hagar dilator size of less than 10. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 1:52](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=112)
- The standard Hagar dilator size for a newborn is about size 12, so a size 10 is 2 deviations less. — Todd Ponsky summarizing the discussion [Ep 5 · 1:57](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=117)
- In the dilation study with 25 children, the types of malformations were evenly distributed and complexity was about equal. — Todd Ponsky summarizing the discussion [Ep 5 · 2:16](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=136)
- Strictures were non-significant between both groups (dilation vs no dilation), and a Heineke-Mikulicz anoplasty (longitudinal incision closed transversely to widen diameter) was able to be performed for stricture management. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 2:26](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=146)
- The number of strictures, number needing anoplasties, and number of redo operations were the same between dilation and no-dilation groups. — Ellen Encisco summarizing the discussion [Ep 5 · 2:55](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=175)
- The number of patients who had rectal prolapse is consistent with the literature. — Ellen Encisco summarizing the discussion [Ep 5 · 3:04](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=184)
- A study of 30-day outcomes for ARM with perineal or rectovaginal fistulas divided patients into early repair (before 6 days old) and late repair (6-8 weeks), with 66 early and 231 late repairs among 291 patients. — Ellen Encisco summarizing the discussion [Ep 5 · 5:20](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=320)
- 30-day complications are not statistically different between early and late repair groups for perineal and rectovaginal fistulas. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 5 · 5:40](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=340)
- A second study defined early repair as 14 days or younger and late as after 14 days, with 31 early and 133 late repairs among 164 patients, also showing no difference in 30-day complications. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 5 · 5:45](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=345)
- Long segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon for the majority of reviewed articles. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 7:27](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=447)
- A contrast study itself is very inaccurate for Hirschsprung disease, and colonic mapping needs to be performed to determine the level of the transition zone. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 7:42](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=462)
- There was no superior or more common operation for long segment Hirschsprung, although Duhamel and Swenson-Soave were the top operations. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 7:51](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=471)
- There are no new novel surgical techniques for Hirschsprung disease over the past several years, though there is potential for stem cell therapy which is still in its infancy. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 8:13](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=493)
- A hypermotility and skin rash protocol for total colonic Hirschsprung disease outlines why an early operation (around 5 months old) is possible. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 8:31](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=511)
- If a child with an ileostomy is adequately prepared and the family can learn to thicken stool, they can have a pull-through that does not result in complete perineal skin breakdown and learn techniques helpful for this difficult-to-toilet-train group. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 8:49](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=529)
- A PCPLC study on bowel management strategies in children with anorectal malformations looked at 624 patients in the 5-12 year old age group. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 5 · 10:36](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=636)
- Even mild and moderate anorectal malformation patients in the 5-12 year old group need to rely on enemas and other bowel management strategies to stay clean when heading into school age. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 5 · 10:45](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=645)
- The majority of ARM patients had constipation as their primary complaint, and only 40% were toilet trained. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 5 · 11:14](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=674)
- A study on timing of pull-through for Hirschsprung disease required all infants to be diagnosed under 1 month of age, with primary pull-throughs performed either less than or greater than 31 days. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 11:38](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=698)
- Preoperative enterocolitis was the same between both timing groups (before and after 31 days), postoperative enterocolitis was the same, and transition zone was the marker if a child needed treatment for constipation. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 11:46](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=706)
- A PCPLC consortium study of 525 ARM patients found that public insurance was associated with decreased rates of urinary incontinence. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 5 · 12:15](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=735)
- Urethral length of about 2.5 centimeters has been measured in VCUGs of normal females, and about 1.5 centimeters is needed for cloacal reconstruction. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 13:26](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=806)
- If a urethra that is too short is pulled past the bladder neck, there is a risk for incontinence. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 13:44](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=824)
- A short vagina, even in an otherwise shorter common channel operation, may require a vaginal replacement. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 13:55](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=835)
- Rotational fluoroscopy and 3D reconstructions are key to being able to make reliable measurements for cloacal anatomy. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 5 · 14:03](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-colorectal-consortium-2021-5357?t=843)
- A single-institution prospective randomized controlled trial from Nationwide compared routine anal dilations versus no dilations following PSARP, with 25 patients in each arm and 12-month follow-up. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 3:35](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=215)
- Stricture was defined as a Hagar dilator size of less than 10, which is 2 standard deviations below the newborn standard of Hagar size 12. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 4:36](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=276)
- In the dilation versus non-dilation arms, strictures occurred in 3 versus 8 patients (non-significant difference), and the number of Heineke-Mikulicz anoplasties needed was equivalent between groups. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 5:29](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=329)
- The number of re-operative surgeries was equivalent between dilation and non-dilation groups (about 2 in each group). — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 6:12](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=372)
- Literature documents a component of psychological dissociation in children who undergo routine anal dilations, measured on later testing. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 4:00](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=240)
- An NSQIP-P study of 291 patients (66 early repair under 6 days, 231 late repair 6 weeks to 8 months) found no statistically significant difference in 30-day complications between early and delayed repair of perineal and rectovesibular fistulas. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 6 · 14:55](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=895)
- A PCPLC study of 164 patients (31 early repair under 14 days, 133 late repair after 14 days) found no difference in 30-day outcomes for perineal and rectovesibular fistula repairs. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 6 · 15:53](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=953)
- Long-segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon in the majority of reviewed articles. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 22:57](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1377)
- Contrast studies are very inaccurate for determining the transition zone in Hirschsprung disease; colonic mapping with biopsies is needed. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 23:38](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1418)
- For long-segment Hirschsprung disease, no superior operation was identified, though Duhamel and Swenson-Soave were the most commonly performed procedures. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 23:55](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1435)
- A European study demonstrated that early operation for total colonic Hirschsprung (around 5 months) is possible if the child with an ileostomy is adequately prepared and the family learns to thicken stool, preventing complete perineal skin breakdown. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 24:23](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1463)
- A PCPLC study of 624 anorectal malformation patients found that 418 (two-thirds) were enrolled in bowel management programs, with constipation as the primary complaint. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 6 · 28:58](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1738)
- In the PCPLC bowel management study, only 40% of anorectal malformation patients were toilet trained, and about half reported daytime stool accidents. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 6 · 29:18](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1758)
- Even patients with mild and moderate anorectal malformations in the 5-12 year age group frequently require enemas and multiple bowel management strategies to maintain cleanliness for school. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 6 · 28:16](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1696)
- A PCPLC study comparing early (under 31 days) versus late (over 31 days) endorectal pull-through for Hirschsprung diagnosed under 1 month found preoperative enterocolitis rates were equivalent (about 2 in each group). — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 30:06](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1806)
- Post-operative enterocolitis rates were equivalent between early and late pull-through groups (40-50% experiencing at least one episode in both groups). — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 30:37](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1837)
- Constipation and incontinence outcomes tracked to 3.5 years were equivalent between early and late pull-through groups for Hirschsprung disease. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 30:46](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1846)
- Transition zone level, rather than timing of pull-through, was the primary marker determining whether a Hirschsprung patient needed treatment for constipation. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 30:55](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1855)
- In spina bifida patients, Hispanic ethnicity and public insurance are associated with lower overall continence rates. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 6 · 32:12](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1932)
- A PCPLC study of 525 anorectal malformation patients found public insurance was associated with decreased rates of urinary incontinence, independent of clinical factors including ARM type, spine, and sacrum. — Caitlin Smith summarizes what Dr. Rebecca Rentea said [Ep 6 · 32:32](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=1952)
- The urethral length in normal females has been measured at about 2.5 centimeters, and approximately 1.5 centimeters is needed to avoid incontinence; pulling a urethra that is too short past the bladder neck creates risk for incontinence. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 35:19](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=2119)
- A short vagina may require vaginal replacement even in an otherwise short common channel cloaca operation. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 35:57](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=2157)
- Rotational fluoroscopy and 3D reconstructions are key to making reliable anatomic measurements for cloacal reconstruction planning. — Rebecca Rentea summarizes what Dr. Caitlin Smith said [Ep 6 · 36:05](https://library.globalcastmd.com/watch/update-course-2021-peds-colorectal-consortium-conclusions-5413?t=2165)
- A careful assessment of existing bowel management plan (sit time, ingredients, flush volume) must be done before the next surgical intervention — The host summarizing the discussion [Ep 12 · 7:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=459)
- Urologists may request bowel work to happen first before determining what is needed for the bladder — Marc Levitt summarizing the discussion [Ep 12 · 8:15](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=495)
- Fecal impaction can push up on the bladder and change the angle of the ureter entering the bladder, causing reflux — Jason Frischer summarizing the discussion [Ep 12 · 8:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=519)
- The last steps of combined procedures should be: mature the Mitrofanoff, mature the Malone, then close the abdomen — Jason Frischer summarizing the discussion [Ep 12 · 10:51](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=651)
- Having families or kids stand up at the end of their flush, move around, and sit back down can help evacuate more stool because things move through their colon differently — The host summarizing the discussion [Ep 12 · 11:54](https://library.globalcastmd.com/watch/colorectal-quiz-episode-16-bowel-management-in-spinal-patients-need-for-a-urologist-part-2-6851?t=714)
- About 5% of colorectal work is surgical and the rest is bowel management — Rebecca Rentea summarizing the discussion [Ep 13 · 1:48](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-6887?t=108)

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