# Vestibular Fistula — GCMD Library living collection

Everything in the library about vestibular fistula — built automatically from dossiers that name it.

Updated: n/a · 5 episodes · 129 cited statements

## Episodes
### Surgical Management
- [Surgical Management Of Female Anorectal Malformation Patients Including...](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741) — video · 57:59 · [machine version](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741.md)
- [Imperforate Anus Rapid Fire: Update Course 2015](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984) — video · 6:54 · [machine version](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984.md)
- [Anorectal Malformation Management of Female Patients Part II: Pediatric...](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090) — video · 28:20 · [machine version](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090.md)
- [Update Course Rewind 2025: Perineal Body–Preserving PSARP: The New Standard?](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867) — video · 2:13 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867.md)

### Case-Based Learning
- [Pediatric Colorectal Contraversies Part II: Pediatric Colorectal...](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416) — video · 31:29 · [machine version](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=0) Vestibular fistula: primary repair versus colostomy timing and technique (Ep 1)
- [5:57](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=357) Recognition of Currarino syndrome and management of anorectal stenosis with presacral mass (Ep 1)
- [9:39](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=579) Colostomy location and technique to prevent prolapse and optimize subsequent repair (Ep 1)
- [19:29](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1169) Loop versus divided colostomy and implications for laparoscopic repair (Ep 1)
- [22:14](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1334) Cloacal malformation: hydrocolpos drainage and urinary decompression strategy (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=0) Introduction and Diagnostic Cases (Ep 2)
- [2:59](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=179) Mobilization Technique and Debate (Ep 2)
- [8:36](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=516) Primary Repair Without Colostomy (Ep 2)
- [16:45](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=1005) Perioperative Management and Research Gaps (Ep 2)
- [24:44](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=1484) Vaginal Anomalies: Septum and Absent Vagina (Ep 2)
- [33:56](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=2036) Vaginal Reconstruction Techniques (Ep 2)
- [44:56](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=2696) Cloaca and Hydrocolpos Management (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=0) Case presentation and initial management options for vestibular fistula (Ep 3)
- [2:35](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=155) Dilation technique and risks of prolonged dilation (Ep 3)
- [3:55](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=235) Sterile meconium concept and timing of repair (Ep 3)
- [5:28](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=328) Management of vestibular fistula with absent vagina (Ep 3)
- [0:01](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1) Vaginal Septa in Vestibular Fistulas: Recognition and Management (Ep 4)
- [5:15](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=315) Vestibular Fistula with Absent Vagina: Diagnosis and Surgical Approach (Ep 4)
- [10:10](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=610) Technical Aspects of Neovagina Construction and Reoperations (Ep 4)
- [17:12](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1032) Cloaca Management: Hydrocolpos and Initial Surgical Approach (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=0) Introduction and Topic Overview (Ep 5)
- [0:32](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=32) Current Practice Patterns and Evidence (Ep 5)
- [1:13](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=73) Technical Discussion and Clinical Considerations (Ep 5)
- [1:51](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=111) Summary and Recommendations (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "First publications on perineal body-preserving PSARP appeared in 2023" (epidemiological) [Ep 5 · 0:46](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=46)
- "At one year follow-up, perineal body-preserving PSARP demonstrated no dehiscence" (clinical) [Ep 5 · 0:46](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=46)
- "At one year follow-up, perineal body-preserving PSARP demonstrated no prolapse" (clinical) [Ep 5 · 0:46](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=46)
- "Only 13% of patients required revision of anal stricture after perineal body-preserving PSARP" (clinical) [Ep 5 · 0:55](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=55)
- "Two-thirds of patients went home on postoperative day one after perineal body-preserving PSARP" — Jill Knepprath (clinical) [Ep 5 · 1:01](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=61)
- "Perineal body-preserving PSARP technique is the same as what one would do in a bulbar fistula but applied to a vestibular fistula" — Nelson (clinical) [Ep 5 · 1:13](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=73)
- "The technique involves cleaning up the lateral planes before coming around the front" — Nelson (clinical) [Ep 5 · 1:22](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=82)
- "Perineal body-preserving PSARP allows patients to go home earlier postoperatively" (clinical) [Ep 5 · 1:32](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=92)
- "With perineal body-preserving PSARP, surgeons do not need to worry about breakdown in the perineal body" (clinical) [Ep 5 · 1:32](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=92)
- "Perineal body-preserving PSARP is harder than opening it all the way anteriorly" (opinion) [Ep 5 · 1:36](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=96)
- "Conversion to standard PSARP is appropriate if uncertain about location of anterior wall or vagina" (guideline) [Ep 5 · 1:36](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=96)
- "Perineal body-preserving PSARP can be a trickier approach than standard PSARP" — Jill Knepprath (opinion) [Ep 5 · 1:51](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=111)
- "Conversion to standard approach is a valid pivot when in doubt about anatomy" — Jill Knepprath (guideline) [Ep 5 · 2:00](https://library.globalcastmd.com/watch/update-course-rewind-2025-perineal-body-preserving-psarp-the-new-standard-11867?t=120)
- "In every single redo of a female anorectal malformation, areolar tissue is found that had never been dissected by the original surgeon, suggesting inadequate anterior rectal wall mobilization led to perineal body disruption." — Mark (clinical) [Ep 2 · 6:38](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=398)
- "The rectal blood supply is intramural, so injuring the rectal wall during dissection hurts its blood supply." — Mark (clinical) [Ep 2 · 14:12](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=852)
- "Starting lateral dissection before attempting to separate the common anterior wall is key; the lateral plane defines the anterior plane." — Mark (host_summary) [Ep 2 · 14:34](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=874)
- "Coming in from lateral to anterior and starting more proximally (where structures are easier to separate) rather than at the perineum improves the dissection plane." — Mark (host_summary) [Ep 2 · 15:25](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=925)
- "A systematic review found that early enteral nutrition appears better than later nutrition in anorectal malformation repair, but all studies were retrospective and poor quality." — Mark (host_summary) [Ep 2 · 19:54](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=1194)
- "About 2 to 5% of vestibular fistulas have a vaginal septum that should be identified at the time of rectal repair." — Mark (epidemiological) [Ep 2 · 27:40](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=1660)
- "Women with longitudinal vaginal septum often learn to work around it for intercourse and may be asymptomatic, but menstrual hygiene (tampon use) is a major reason for resection." — Mark (host_summary) [Ep 2 · 30:32](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=1832)
- "Vaginal septum resection in adolescents is not a difficult operation and can be done with electrocautery, getting as close to the cervix as possible without damaging it." — Mark (host_summary) [Ep 2 · 31:29](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=1889)
- "If a vaginal septum is found in a 6-year-old after anorectal malformation repair, there is no rush to remove it before puberty unless another operation is planned." — Mark (host_summary) [Ep 2 · 42:29](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=2549)
- "Of 33 patients with vestibular fistula and absent vagina, 75% had urologic problems including neurogenic bladder, and 50% had CKD stage 3 or greater." (epidemiological) [Ep 2 · 37:17](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=2237)
- "Vestibular fistula with absent vagina requires aggressive urologic screening due to high rates of solitary kidneys, reflux, hydronephrosis, neurogenic bladder, and urinary tract infections." (clinical) [Ep 2 · 37:31](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=2251)
- "For absent vagina with vestibular fistula, sigmoid neovagina is preferred, using sigmoid colon mobilized laparoscopically and brought to the perineum, with backup colostomy." — Mark (host_summary) [Ep 2 · 34:56](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=2096)
- "The ideal time to create a neovagina is when fixing the rectum, because the perineal body is open and the sigmoid pedicle reaches more easily in younger children with shorter pelvis." — Mark (opinion) [Ep 2 · 39:35](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=2375)
- "About 50% of cloacas have a bifid gynecologic system." — Mark (epidemiological) [Ep 2 · 45:50](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=2750)
- "For newborn cloaca with hydrocolpos, an open divided colostomy should be performed, and the vagina decompressed with a pigtail catheter rather than formal vaginostomy." — Mark (host_summary) [Ep 2 · 46:12](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=2772)
- "Cystoscopy at the time of colostomy creation in cloaca makes the colostomy creation very difficult and should be avoided; scope at 2–3 months instead." — Mark (host_summary) [Ep 2 · 46:48](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=2808)
- "Intermittent catheterization of the cloaca 2–3 times daily can drain urine from the vagina and avoid the need for vaginostomy tube in many cases." — Mark (host_summary) [Ep 2 · 51:09](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=3069)
- "Catheterization of cloaca should be done under ultrasound guidance initially to ensure the catheter enters the correct structure (right vagina, left vagina, bladder, or rectum)." — Mark (clinical) [Ep 2 · 52:02](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=3122)
- "In hydrocolpos compressing the ureters, once the hydrocolpos is drained, the bladder fills beautifully, demonstrating the physiology of ureteral compression." — Mark (host_summary) [Ep 2 · 53:50](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=3230)
- "Most patients with hydrocolpos can be successfully drained by draining the hydrocolpos only, without needing to drain the bladder separately." — Mark (clinical) [Ep 2 · 54:04](https://library.globalcastmd.com/watch/surgical-management-of-female-anorectal-malformation-patients-including-741?t=3244)
- "For vestibular fistula, Professor Liam prefers primary repair around day 5-7 of life" — Em Gootee (host_summary) [Ep 1 · 0:34](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=34)
- "Primary repair is preferred in the neonatal period with a very nice fistula; older patients may require colostomy" (clinical) [Ep 1 · 1:14](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=74)
- "Primary repair can be performed up to 3-4 months of age if surgeon is confident; otherwise two-operation approach is used" (clinical) [Ep 1 · 1:32](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=92)
- "Teenagers repaired with classical three-operation approach have beautiful perineum and perfect function" (clinical) [Ep 1 · 2:28](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=148)
- "Patients repaired primarily 7-8 years ago have more stenosis and adhesions because feces pass through during healing even with fasting" (clinical) [Ep 1 · 2:57](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=177)
- "Vestibular fistula patients with normal sacrum and no cord have excellent prognosis with good operation" (clinical) [Ep 1 · 3:46](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=226)
- "For babies born in hospital, operate within first 72 hours before colonization occurs" (clinical) [Ep 1 · 4:34](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=274)
- "For 6-month-old baby with megacolon, clean colon with GoLYTELY completely, then central line with 7-10 days NPO on parenteral nutrition before repair" (clinical) [Ep 1 · 4:58](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=298)
- "Oval-shaped anus with no radiating streaks is very specific for Currarino syndrome" — Sabine (clinical) [Ep 1 · 6:35](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=395)
- "Presacral mass corresponds to either anorectal stenosis (mass just in front of stenosis) or Currarino syndrome" — Sabine (clinical) [Ep 1 · 7:43](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=463)
- "About 30-40% of anorectal stenosis or rectal atresia cases will have a presacral mass" — Em Gootee (epidemiological) [Ep 1 · 8:38](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=518)
- "MRI is the best way to show a presacral mass" — Em Gootee (clinical) [Ep 1 · 8:45](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=525)
- "For anorectal stenosis repair, open posteriorly only to preserve anterior dentate line and avoid anterior rectal dissection" — Em Gootee (clinical) [Ep 1 · 8:57](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=537)
- "Opening colostomy in mobile portion of colon will cause severe prolapse" (clinical) [Ep 1 · 12:23](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=743)
- "Opening colostomy in fixed portion of colon (end of descending colon) prevents prolapse" (clinical) [Ep 1 · 12:02](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=722)
- "Mucous fistula should be reduced in size and made tiny, only necessary for irrigation and diagnostic tests" (clinical) [Ep 1 · 13:32](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=812)
- "Loop colostomy is never completely diverting no matter how much surgeons believe it is" — Em Gootee (clinical) [Ep 1 · 14:37](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=877)
- "Spillage across loop colostomy causes urinary tract infections in patients with fistulas" — Em Gootee (clinical) [Ep 1 · 15:05](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=905)
- "Cleaning out distal colon at colostomy creation takes about 20-30 minutes and is very important" — Em Gootee (clinical) [Ep 1 · 15:42](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=942)
- "Transverse colostomy dysfunctionalizes a very long piece of colon" (clinical) [Ep 1 · 16:19](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=979)
- "It is extremely difficult to do a good distal colostogram through transverse colostomy because of difficulty applying enough hydrostatic pressure" (clinical) [Ep 1 · 16:27](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=987)
- "Colon perforation with distal colostogram occurred mainly through transverse colostomy" (clinical) [Ep 1 · 16:58](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1018)
- "Cleaning colon distal to transverse colostomy is almost impossible, leaving pool of meconium that colonizes" (clinical) [Ep 1 · 17:07](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1027)
- "With transverse colostomy and rectourinary fistula, urine gets trapped in colon, is absorbed, and can cause hyperchloremic acidosis" (clinical) [Ep 1 · 17:30](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1050)
- "Long-term transverse colostomy causes distal colon to become extremely dilated and full of meconium" (clinical) [Ep 1 · 17:49](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1069)
- "There is a direct relationship between degree of megacolon and degree of constipation the patient will have" (clinical) [Ep 1 · 18:40](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1120)
- "Loop colostomies have more prolapse than separated colostomies" (clinical) [Ep 1 · 18:59](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1139)
- "Distal sigmoid colostomy makes laparoscopic operation more difficult and may require opening to take down mucous fistula" — Em Gootee (clinical) [Ep 1 · 21:07](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1267)
- "For laparoscopic repair, distal colostomy can act as traction to help dissect fistula, then take down and open new one simultaneously" (clinical) [Ep 1 · 21:37](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1297)
- "Cloaca is rarely diagnosed prenatally in second trimester; third trimester ultrasound more common" (clinical) [Ep 1 · 22:52](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1372)
- "Midline abdominal mass in cloaca patient is always hydrocolpos; never seen a cloaca with that mass that was not hydrocolpos" (clinical) [Ep 1 · 24:42](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1482)
- "Hydrocolpos compresses bladder trigone and produces acquired ureterovesical obstruction with megaureters and hydronephrosis" (clinical) [Ep 1 · 25:56](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1556)
- "Draining hydrocolpos makes hydronephrosis disappear" (clinical) [Ep 1 · 26:18](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1578)
- "Unnecessary nephrostomy, ureterostomy, or vesicostomy may be performed if urologist does not recognize that hydrocolpos drainage is the key" (clinical) [Ep 1 · 26:23](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1583)
- "Consequences of not draining hydrocolpos are urosepsis and infected hydrocolpos (pyocolpos) that permanently damages vagina" (clinical) [Ep 1 · 27:10](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1630)
- "Transperineal catheter drainage of hydrocolpos will come out in two days and hydrocolpos will reform" (clinical) [Ep 1 · 27:45](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1665)
- "Drain hydrocolpos with permanent catheter through abdomen, not by dilating common channel" (clinical) [Ep 1 · 27:52](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1672)
- "Best tube for hydrocolpos drainage is curled pigtail tube because hydrocolpos recedes into pelvis over months; straight tube will fall out" — Em Gootee (clinical) [Ep 1 · 28:14](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1694)
- "Interventional radiology can drain hydrocolpos under ultrasound guidance if it is large enough and close to abdominal wall" (clinical) [Ep 1 · 29:04](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1744)
- "Vesicostomy is indicated when common channel is almost atretic and baby has difficulty emptying bladder after hydrocolpos drainage" (clinical) [Ep 1 · 30:41](https://library.globalcastmd.com/watch/pediatric-colorectal-contraversies-part-ii-pediatric-colorectal-416?t=1841)
- "In vestibular fistulas where the opening is very close to the expected anal position, the perineal anatomy can improve significantly within a few weeks to a month, with the distance from the expected anus decreasing over time." (clinical) [Ep 3 · 1:17](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=77)
- "As long as the child is stooling adequately, there is no urgency to perform definitive repair, and waiting at least a month to observe anatomic evolution is appropriate." (opinion) [Ep 3 · 1:49](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=109)
- "Management of vestibular fistulas varies widely among pediatric surgeons, with some performing dilations, some doing primary operations, and some doing colostomies." (epidemiological) [Ep 3 · 2:01](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=121)
- "Expert surgeons may be able to perform primary repair in the newborn period, but routine pediatric surgeons may not have the same capability." (opinion) [Ep 3 · 2:14](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=134)
- "Primary repair in a newborn is technically challenging because it is hard to identify where the sphincter should be and the dissection plane between vagina and rectum is much thinner." — Belinda (clinical) [Ep 3 · 2:41](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=161)
- "In settings without access to TPN and IV fluids where anoplasty healing is critical, colostomy with delayed repair may be more appropriate than primary repair." — Belinda (clinical) [Ep 3 · 2:55](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=175)
- "Prolonged dilations cause scarring and inflammation that can make subsequent surgical repair more difficult." — Belinda (clinical) [Ep 3 · 3:20](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=200)
- "Dilations should typically be limited to size 7 or 8, with patients maintained on stool softeners." — Belinda (clinical) [Ep 3 · 3:29](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=209)
- "Dilations up to size 11 or 12 make subsequent repair technically difficult." — Belinda (clinical) [Ep 3 · 3:33](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=213)
- "Dissection at 3 or 6 months of age can be just as tedious as newborn repair if dilations have caused local trauma." (clinical) [Ep 3 · 3:40](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=220)
- "Traditional teaching held that operations should be performed in the newborn period when meconium is sterile, rather than at 2-3 months when stool is colonized, and that if waiting 2-3 months, colostomy should be performed to divert stool." (host_summary) [Ep 3 · 4:01](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=241)
- "Conservative postoperative management includes keeping patients NPO for about a week and providing hyperalimentation (a 'medical colostomy'), though there is no data to support this approach." (clinical) [Ep 3 · 4:30](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=270)
- "Some pediatric surgeons repair anorectal malformations at any age with colonized stool present and feed the child on postoperative day 1 or 2, with probably similar complication rates." (host_summary) [Ep 3 · 4:52](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=292)
- "The primary reason for not operating in the immediate newborn period is the technical difficulty of the dissection, not concerns about stool sterility." (opinion) [Ep 3 · 5:09](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=309)
- "It is harder to identify the exact center of the sphincter in a 2 kg baby than in an 8 or 9 kg baby." (clinical) [Ep 3 · 5:18](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=318)
- "In a patient with vestibular fistula and absent vagina who has good prognosis for bowel control, the operation should either be aborted for later definitive planning, or a graft (colon or small bowel) can be used to replace the vagina while bringing the rectum/fistula down as a pull-through." (clinical) [Ep 3 · 5:57](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=357)
- "In a patient with vestibular fistula and absent vagina who has poor prognosis for bowel control (such as those with sacral agenesis, tethered cord, or other conditions), the rectum/fistula can be used as the vagina and a more proximal piece of colon brought down as the pull-through." (clinical) [Ep 3 · 6:23](https://library.globalcastmd.com/watch/imperforate-anus-rapid-fire-update-course-2015-984?t=383)
- "2 to 5% of vestibular fistulas have a vaginal septum" (epidemiological) [Ep 4 · 0:01](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1)
- "The ideal time to remove a vaginal septum is when the rectum is being mobilized and the perineal body is open" (clinical) [Ep 4 · 0:18](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=18)
- "Women with longitudinal vaginal septa often learn to use one side of the vagina more than the other during intercourse and are often not bothered" — Jerry (clinical) [Ep 4 · 2:37](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=157)
- "During labor, women with longitudinal vaginal septa often blow the septum out, which can be repaired at that time" — Jerry (clinical) [Ep 4 · 2:57](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=177)
- "Menstrual hygiene is a major reason to remove vaginal septa - patients report needing tampons on each side or requiring both tampon and pad" — Jerry (clinical) [Ep 4 · 3:10](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=190)
- "Resecting a vaginal septum in an adolescent is not a difficult operation and can be done with electrocautery, getting as close to the cervix as possible without damaging it" — Jerry (clinical) [Ep 4 · 3:50](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=230)
- "In vestibular fistula, visual inspection of the introitus with spreading of an instrument is obligatory to look for vaginal septa" (clinical) [Ep 4 · 4:11](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=251)
- "97% of vestibular fistula patients have normal vaginal anatomy without septa" (epidemiological) [Ep 4 · 5:04](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=304)
- "For vestibular fistula with absent vagina, sigmoid colon can be used as a vaginoplasty" — Don (clinical) [Ep 4 · 7:32](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=452)
- "In absent vagina cases, the rectal fistula can be dilated without doing a colostomy, because a sigmoid colostomy would interfere with blood supply needed for sigmoid vaginoplasty" — Don (clinical) [Ep 4 · 7:42](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=462)
- "Sigmoid vaginoplasty and imperforate anus repair can be done in one stage laparoscopically with a backup colostomy" — Don (clinical) [Ep 4 · 8:06](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=486)
- "An alternative to sigmoid neovagina is to use the rectum as vagina and mobilize more proximal rectum down as neo-rectum" (clinical) [Ep 4 · 8:45](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=525)
- "Using rectum as vagina should only be done if the patient is unlikely to be continent, such as with spinal anomaly or absent sacrum, because rectum has value for continence" (clinical) [Ep 4 · 8:58](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=538)
- "Of 33 patients with absent vagina, 75% had urologic problems including neurogenic bladder" — Shammael (epidemiological) [Ep 4 · 9:38](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=578)
- "Of patients with absent vagina, 50% had CKD stage 3 or greater" — Shammael (epidemiological) [Ep 4 · 9:47](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=587)
- "Solitary kidneys, reflux, hydronephrosis, neurogenic bladder, and urinary tract infections are long-term sequelae in patients with absent vagina" — Shammael (clinical) [Ep 4 · 9:52](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=592)
- "Once absent vagina is diagnosed, aggressive screening of the urinary tract must be employed" — Shammael (clinical) [Ep 4 · 10:02](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=602)
- "Male ARM with any associated urologic problem requires urology collaboration" (guideline) [Ep 4 · 10:16](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=616)
- "Vestibular fistula with absent vagina is an important category requiring urology collaboration because a large percentage have serious urologic problems" (clinical) [Ep 4 · 10:24](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=624)
- "In absent vagina, the rectum separates nicely from the urethra with thick fibrous tissue, less adherent than rectum to posterior vagina" (clinical) [Ep 4 · 10:38](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=638)
- "Gynecologists typically recommend teenager age for vaginal reconstruction in isolated vaginal anomalies" (host_summary) [Ep 4 · 11:09](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=669)
- "The ideal time to fix the vagina is when fixing the rectum because the perineal body is open" (opinion) [Ep 4 · 11:53](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=713)
- "Neovagina is technically easier in younger children because the sigmoid pedicle reaches more easily when the pelvis is shorter" (clinical) [Ep 4 · 12:04](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=724)
- "For premenarchal girls with vaginal septum already missed at primary repair, there is no rush to operate unless another procedure is planned" — Jerry (clinical) [Ep 4 · 15:08](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=908)
- "A patient can have an isolated longitudinal vaginal septum with one Müllerian system, or two cervices indicating duplicated system" — Jerry (clinical) [Ep 4 · 15:33](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=933)
- "Vaginoscopy to identify one versus two cervices is important in determining whether a vaginal septum represents isolated septum or duplicated Müllerian system" — Jerry (clinical) [Ep 4 · 15:33](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=933)
- "There are two types of cloacas: lower ones (13 cm common channel or less) and complicated ones (13 cm or greater)" (clinical) [Ep 4 · 17:32](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1052)
- "Making the distinction between low and high cloacas helps avoid trouble in management" (opinion) [Ep 4 · 17:32](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1052)
- "Hydrocolpos may obstruct the distal ureters and cause bilateral hydronephrosis" (clinical) [Ep 4 · 17:59](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1079)
- "About 50% of cloacas have a duplicated gynecologic system" (epidemiological) [Ep 4 · 18:11](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1091)
- "For newborn cloaca with hydrocolpos, management includes open divided colostomy and decompression of vagina with pigtail catheter rather than formal vaginostomy" — Jack (clinical) [Ep 4 · 18:30](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1110)
- "Creating a colostomy can be challenging when hydrocolpos is very dilated, occasionally requiring vaginal decompression first" — Jack (clinical) [Ep 4 · 18:51](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1131)
- "Attempting cystoscopy at the time of colostomy creation in cloaca makes the colostomy very difficult" — Jack (clinical) [Ep 4 · 19:08](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1148)
- "For newborn cloaca, recommendation is to just divert and deal with vaginostomy without scoping at that time" (opinion) [Ep 4 · 19:28](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1168)
- "Scoping the vagina can be done at 2-3 months of age with better visualization and is more pleasant than doing it in the newborn period" (opinion) [Ep 4 · 19:45](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1185)
- "Laparoscopic approach for hydrocolpos management includes left upper quadrant port for visualization, right lower quadrant percutaneous vaginostomy tube, and left lower quadrant diverting colostomy" (host_summary) [Ep 4 · 21:13](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1273)
- "For large hydrocolpos that comfortably reaches the abdominal wall, a sutured tubeless vaginostomy can be done" (clinical) [Ep 4 · 22:00](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1320)
- "For hydrocolpos lower than abdominal wall, ideal is tube vaginostomy using a curled tube (Pezzer or Malecot) rather than straight tube" (clinical) [Ep 4 · 22:00](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1320)
- "With straight tube vaginostomy, as hydrocolpos recedes and inflammation resolves at about 2 months, the tube falls out, whereas curled tubes stay in place" (clinical) [Ep 4 · 22:23](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1343)
- "Much of hydrocolpos fluid can be vaginal secretions, but much can also be urine refluxing up" — Don (clinical) [Ep 4 · 22:49](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1369)
- "Urine is often as big a problem as vaginal dilatation in hydrocolpos" — Don (clinical) [Ep 4 · 22:56](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1376)
- "Alternative to tube vaginostomy is having family intermittently catheterize the cloaca 2-3 times daily to drain urine" (clinical) [Ep 4 · 23:30](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1410)
- "After the newborn period, the uterus stops secreting and most fluid in vaginal part of cloaca is urine refluxing back" (clinical) [Ep 4 · 23:37](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1417)
- "As vagina distends in cloaca, it obstructs the urethra causing more urine to leak into vagina in a perpetuating cycle" (clinical) [Ep 4 · 23:58](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1438)
- "Intermittent catheterization teaching should be done under ultrasound because the tube can go into right vagina, left vagina, bladder, or rectum" (clinical) [Ep 4 · 24:23](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1463)
- "Without ultrasound guidance, you may go 3 days without draining the correct vagina in duplicated systems" (clinical) [Ep 4 · 24:43](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1483)
- "Blind passage of catheter through perineum generally does not drain the structures you want to drain" (clinical) [Ep 4 · 24:51](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1491)
- "In one case, bedside ultrasound showed very dilated hemivaginas with echogenic fluid (probably meconium and urine) and patient creatinine was about 4" — Jack (clinical) [Ep 4 · 25:29](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1529)
- "Ultrasound-guided tube placement for hydrocolpos drainage can be done in the ICU" — Jack (clinical) [Ep 4 · 25:52](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1552)
- "Before draining hydrocolpos, the bladder cannot be seen on ultrasound; after drainage, the bladder fills beautifully, demonstrating the physiology of ureteral compression" (clinical) [Ep 4 · 26:05](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1565)
- "In most patients, draining the hydrocolpos alone is sufficient; rarely you also need to drain the bladder" (clinical) [Ep 4 · 26:26](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1586)
- "In duplicated vaginal systems, both sides must be drained or only one side of hydronephrosis will improve" (clinical) [Ep 4 · 26:34](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1594)
- "During colostomy opening, the dome of hydrocolpos can be opened and some septum removed to create a single chamber" (clinical) [Ep 4 · 26:58](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1618)
- "If tube vaginostomy is placed and operation planned in a couple months, it may be difficult to bring the vagina down because it becomes fixed" (clinical) [Ep 4 · 27:28](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1648)
- "For very large hydrocolpos, you will almost always need to be in the abdomen anyway and can take down the vaginostomy at that time" (clinical) [Ep 4 · 27:50](https://library.globalcastmd.com/watch/anorectal-malformation-management-of-female-patients-part-ii-pediatric-1090?t=1670)

## Changelog
- Sep 9: 1 item no longer name vestibular fistula
- Sep 8: 1 item added automatically
- Sep 7: 5 items added automatically

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