# Spina Bifida — GCMD Library living collection

Everything in the library about spina bifida — built automatically from dossiers that name it.

Updated: n/a · 4 episodes · 82 cited statements

## Episodes
### Surgical Management
- [Fetoscopic Repair of Myelomeningocele (MMC)](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391) — podcast · 5:52 · [machine version](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391.md)

### Evidence & Research
- [Fetal Surgical Intervention for Myelomeningocele: Fetal Surgery 2012](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026) — video · 165:47 · [machine version](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026.md)

### Case-Based Learning
- [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)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=0) General Fetal Surgery Discussion: Steroids for CCAM and SCT (Ep 1)
- [20:00](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=1200) Minimally Invasive Approaches and Technology for Fetal Tumors (Ep 1)
- [45:00](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=2700) Establishing Fetal Surgery Centers: Requirements and Challenges (Ep 1)
- [65:00](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=3900) Video: CHOP Fetal Treatment Center Overview (Ep 1)
- [80:50](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=4850) Myelomeningocele: Pathophysiology and Rationale for Fetal Surgery (Ep 1)
- [111:40](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6700) The MOMS Trial: Design, Execution, and Results (Ep 1)
- [125:00](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=7500) Post-MOMS Experience and Center Development Guidelines (Ep 1)
- [141:40](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=8500) Innovation, Fetoscopic Approaches, and Future Directions (Ep 1)
- [158:20](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=9500) Shunt Criteria Discrepancies and Neurosurgical Perspective (Ep 1)
- [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)
- [0:00](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=0) Introduction to Fetoscopic Myelomeningocele Repair (Ep 4)
- [1:13](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=73) Myelomeningocele Pathology and Timing (Ep 4)
- [1:51](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=111) Surgical Access and Port Placement (Ep 4)
- [3:08](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=188) Placode Untethering (Ep 4)
- [3:44](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=224) Defect Closure with Patches and Skin (Ep 4)
- [4:49](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=289) Procedure Completion and Postoperative Care (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Spina bifida affects approximately 1500 babies born per year in the US, about 30 per week or 5-6 per day." — Scott Adzik (epidemiological) [Ep 1 · 82:06](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=4926)
- "With standard postnatal care, approximately 14% of MMC patients die by age 5, mostly due to symptomatic brain stem compression from hindbrain herniation." — Scott Adzik (clinical) [Ep 1 · 83:20](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5000)
- "About 85% of MMC patients require ventricular shunts with standard postnatal care, with approximately half developing shunt complications within one year." — Scott Adzik (clinical) [Ep 1 · 83:33](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5013)
- "The two-hit hypothesis for MMC proposes that secondary damage occurs in utero from amniotic fluid, meconium, or hydrodynamic forces after the initial failure of neurulation." — Scott Adzik (clinical) [Ep 1 · 83:41](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5021)
- "In fetal sheep models, mid-gestational spinal cord exposure leads to progressive neurologic injury that mimics human MMC, with paralysis and loss of sensation below the lesion level." — Scott Adzik (clinical) [Ep 1 · 86:09](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5169)
- "In utero coverage of experimentally created MMC in fetal sheep rescues neurologic function at birth, with lambs able to stand, walk, and maintain continence." — Scott Adzik (host_summary) [Ep 1 · 86:43](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5203)
- "Hindbrain herniation reverses after prenatal MMC repair because closing the defect prevents CSF leak, reestablishing the pressure column in the spinal canal." — Scott Adzik (clinical) [Ep 1 · 90:15](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5415)
- "In CHOP's pre-MOMS experience with 50 fetal MMC repairs, the shunt rate by one year was 40%, compared to 85% with postnatal repair." — Scott Adzik (clinical) [Ep 1 · 93:10](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5590)
- "Two-thirds of prenatally repaired MMC patients showed motor function two or more levels better than the anatomic lesion level." — Scott Adzik (clinical) [Ep 1 · 93:41](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5621)
- "The MOMS trial was stopped early on December 7, 2010 by the Data Safety Monitoring Board due to demonstrated efficacy of prenatal surgery." — Scott Adzik (clinical) [Ep 1 · 102:18](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6138)
- "In the MOMS trial, shunts were placed in 40% of the prenatal surgery group compared to 82% of the postnatal surgery group." — Scott Adzik (clinical) [Ep 1 · 102:55](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6175)
- "At 30 months, 42% of babies in the prenatal surgery group could walk independently versus only 21% in the postnatal surgery group." — Scott Adzik (clinical) [Ep 1 · 103:31](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6211)
- "Mean gestational age at delivery was 34 weeks in the prenatal surgery group versus 37 weeks in the postnatal group, with 13% of prenatal cases delivered before 30 weeks." — Scott Adzik (clinical) [Ep 1 · 104:57](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6297)
- "At the time of delivery in the MOMS trial, the hysterotomy site was intact in about two-thirds of cases, very thin in one-quarter, with dehiscence in 9% and complete dehiscence in one case." — Scott Adzik (clinical) [Ep 1 · 104:32](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6272)
- "Since the end of the MOMS trial, CHOP has had 359 referrals, with 202 evaluated on-site, but only 60 (30%) underwent fetal surgery." — Scott Adzik (clinical) [Ep 1 · 107:57](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6477)
- "Fetal MRI is mandatory for preoperative evaluation because ultrasound alone can incorrectly identify hindbrain herniation; in 9 cases with absent hindbrain herniation on MRI, ultrasound showed positive or equivocal findings." — Scott Adzik (clinical) [Ep 1 · 109:07](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6547)
- "Fetoscopic MMC repair using 3 or more ports leads to membrane fixation and tearing with uterine growth, resulting in premature birth 3-6 weeks after surgery and delivery before 30 weeks as a rule." — Scott Adzik (clinical) [Ep 1 · 109:47](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6587)
- "Compared to open fetal MMC repair, fetoscopic repair has higher rates of fetal death, premature rupture of membranes, chorioamnionitis, oligohydramnios, premature delivery, and persistent hindbrain herniation." — Scott Adzik (clinical) [Ep 1 · 110:06](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6606)
- "There have been three maternal deaths associated with open fetal surgery for MMC in South America (one in Colombia, two in Argentina)." — Todd Ponsky (host_summary) [Ep 1 · 132:16](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=7936)
- "In the US experience with open fetal surgery for MMC, there have been no maternal deaths and no serious maternal complications in recent years." — Todd Ponsky (clinical) [Ep 1 · 133:43](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=8023)
- "Longer operating room times and postoperative oligohydramnios correlate with increased risk for preterm birth in fetal MMC repair." — Scott Adzik (clinical) [Ep 1 · 106:17](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6377)
- "A Washington University financial model using MOMS trial data showed that over $3 million would be saved for 100 babies treated prenatally versus postnatally." — Scott Adzik (host_summary) [Ep 1 · 107:07](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6427)
- "In Europe, approximately one-third of mothers decline open fetal MMC surgery because it is an open procedure." — Todd Ponsky (epidemiological) [Ep 1 · 146:39](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=8799)
- "For proper neurosurgical repair of cystic MMC, it is essential to remove the cyst and excise tissues that don't belong, not simply cover the lesion—a step that may be missing in some fetoscopic approaches." — Todd Ponsky (clinical) [Ep 1 · 147:34](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=8854)
- "In the MOMS trial, 51% of prenatally repaired children met shunt criteria, but only 31 actually received shunts (approximately 65% of those meeting criteria), compared to 66 of 74 (89%) in the postnatal group." — Todd Ponsky (clinical) [Ep 1 · 150:23](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=9023)
- "The discrepancy between meeting shunt criteria and receiving shunts occurred because an independent neurosurgical review committee determined criteria, but individual neurosurgeons made placement decisions, and most discrepancies involved criterion 3 (head size/ventricle changes) without accompanying symptoms." — Scott Adzik (host_summary) [Ep 1 · 154:14](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=9254)
- "Using revised shunt criteria based on modified criterion 3, there is a close match between shunt criteria and actual shunt placement in both prenatal (46%) and postnatal (86%) groups." — Scott Adzik (host_summary) [Ep 1 · 156:43](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=9403)
- "About 5% of colorectal work is surgical and the rest is bowel management." — Rebecca Rentia (host_summary) [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)
- "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)
- "Senna rash may be related to the formulation (tablet, liquid, or chocolate squares) or to prolonged contact with stool, particularly overnight." — Marc Levitt (host_summary) [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)
- "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 Rentia (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 Rentia (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 Rentia (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)
- "Careful assessment of existing bowel management including sit time, ingredients, and flush volume is necessary before the next surgical intervention" (host_summary) [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)
- "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)
- "Fecal impaction can push on the bladder and change the angle of the ureter entering the bladder, causing reflux" — Jason Frischer (host_summary) [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)
- "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)
- "The last steps of combined procedures should be maturing the Mitrofanoff, maturing the Malone, then closing the abdomen" — Jason Frischer (host_summary) [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)
- "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)
- "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 (host_summary) [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)
- "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)
- "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 (host_summary) [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)
- "Neural tube defects are the most common congenital central nervous system anomaly." — Rod Gerardo (host_summary) [Ep 4 · 0:42](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=42)
- "Myelomeningocele or spina bifida is the most common neural tube defect." — Rod Gerardo (host_summary) [Ep 4 · 1:20](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=80)
- "In myelomeningocele, the patient is born with a cleft in the vertebral column and a defect in the skin, so the meninges and the spinal cord are exposed." — Rod Gerardo (host_summary) [Ep 4 · 1:25](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=85)
- "The patient may be left with neural defects based on the level of the spinal cord where the lesion is." — Rod Gerardo (host_summary) [Ep 4 · 1:33](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=93)
- "Prenatal repair is most commonly done between 22 and 26 weeks gestation." — Fung Lim (clinical) [Ep 4 · 1:44](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=104)
- "For maternal access, either a transverse incision or a midline incision may be used." — Fung Lim (clinical) [Ep 4 · 1:54](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=114)
- "Under ultrasound guidance, the first port is placed." — Rod Gerardo (host_summary) [Ep 4 · 2:17](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=137)
- "The amniotic cavity is expanded using humidified and heated carbon dioxide, which creates more space to do the repair." — Fung Lim (clinical) [Ep 4 · 2:22](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=142)
- "A camera is inserted into the amniotic cavity through the first port to enable visualization inside the womb." — Fung Lim (clinical) [Ep 4 · 2:34](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=154)
- "Two additional ports are placed under direct vision to allow placement of instruments for the repair." — Fung Lim (clinical) [Ep 4 · 2:43](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=163)
- "Anesthesia is induced on the baby via an intragluteal injection." — Rod Gerardo (host_summary) [Ep 4 · 2:51](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=171)
- "A stabilization stitch is placed in the baby's upper back above the spina bifida." — Fung Lim (clinical) [Ep 4 · 2:56](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=176)
- "The first step is to open the sac, then dissect around the sac circumferentially." — Rod Gerardo (host_summary) [Ep 4 · 3:08](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=188)
- "Once the sac is completely open, the placode is freed." — Fung Lim (clinical) [Ep 4 · 3:22](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=202)
- "The placode is the open area of exposed neural tissue." — Rod Gerardo (host_summary) [Ep 4 · 3:27](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=207)
- "Untethering allows the placode to fall back down nicely into the spinal canal." — Fung Lim (clinical) [Ep 4 · 3:34](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=214)
- "A skin flap is created to loosen up the skin, which will help form a watertight closure of the spinal defect." — Rod Gerardo (host_summary) [Ep 4 · 3:44](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=224)
- "To protect the placode, a patch is placed into the defect and anchored on one end to the baby's back using dissolvable sutures." — Fung Lim (clinical) [Ep 4 · 3:57](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=237)
- "A second patch is placed to give additional protection and is secured with dissolvable sutures." — Fung Lim (clinical) [Ep 4 · 4:08](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=248)
- "The skin is closed over the spinal defect using dissolvable sutures when the baby has enough skin to do so." — Fung Lim (clinical) [Ep 4 · 4:17](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=257)
- "When the defect is too big and the two ends of skin cannot be pulled together, a skin patch is used to form a watertight closure." — Fung Lim (clinical) [Ep 4 · 4:26](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=266)
- "Port sites are closed with dissolvable sutures." — Fung Lim (clinical) [Ep 4 · 4:49](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=289)
- "The amniotic fluid that was removed is replaced with warm fluid and antibiotics are placed into the amniotic cavity." — Fung Lim (clinical) [Ep 4 · 4:57](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=297)
- "The mother and the fetus are monitored postoperatively, and if able, the baby is delivered vaginally at term." — Rod Gerardo (host_summary) [Ep 4 · 5:14](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=314)

## Changelog
- Sep 9: 1 item added automatically
- Sep 7: 3 items added automatically

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