If the urethra is less than one and a half centimeters, we'd advocate for a urogenital separation. And the reason for that is if you were to do a TUM on a patient with a one centimeter urethra, and although these patients aren't common, they do exist, then you will have their bladder neck sewn right near the perineum. And that could render the patient incontinent.
I think if you look at these pictures we have, you can see when we're looking at a lateral view, how the common channel actually takes a very significant turn as it gets behind the pubis.
The Colorectal Quiz Episode 9: Motility Disorders Part 2
▶Ep 93 · 5:17
opinionSitz marker study is not a replacement for colonic manometry↗
The Colorectal Quiz Episode 10: Total Colonic Hirschsprung Disease Part 1
▶Ep 94 · 3:30
clinicalIn meconium plug cases, the initial contrast enema may show what appears to be a meconium plug but is actually a segment of Hirschsprung disease↗
▶Ep 94 · 3:53
clinicalAfter meconium passes in suspected Hirschsprung cases, obtaining another contrast image can reveal the characteristic appearance of Hirschsprung disease↗
▶Ep 94 · 4:21
clinicalRare causes of failure to pass meconium include small left colon syndrome, hypothyroidism, opiates in the newborn system, magnesium sulfate exposure, milk protein allergy, and microcolon intestinal hypoperistalsis syndrome↗
▶Ep 94 · 8:03
guidelineRectal biopsies should be attempted pre-operatively before proceeding to the operating room↗
▶Ep 94 · 8:53
guidelineIf a patient is not doing well with irrigations, a procedure to relieve pressure such as ileostomy or leveling colostomy is necessary↗
▶Ep 94 · 9:04
guidelineLoop ostomies should be avoided in Hirschsprung disease because stool may spill into the non-functional part of the colon↗
▶Ep 94 · 9:35
guidelineWhen no transition zone is visible during surgery, additional biopsies should be obtained at multiple sites along the colon↗
▶Ep 94 · 10:09
guidelineA definitive pull-through procedure should not be performed based solely on frozen section if there is uncertainty about the diagnosis↗
The Colorectal Quiz Episode 11: Total Colonic Hirschsprung's Part 2
▶Ep 95 · 3:59
clinicalHigh ileostomy output can be managed with pectin or Imodium to thicken stools↗
▶Ep 95 · 7:08
clinicalSodium is actively absorbed in the ileum but passively absorbed in the jejunum↗
Colorectal Quiz Episode 13: Newborn ARM Part 2
▶Ep 98 · 6:10
clinicalCongenital perineal groove has a normal anal opening and is an exposed wet sulcus of non-keratinized mucous membrane that usually epithelializes on its own by age two↗
▶Ep 98 · 9:11
clinicalThree qualities to assess in anal location are: anal size, location (whether surrounded by sphincter muscle complex), and the peroneal body that separates it from the introitus or urinary structures↗
▶Ep 98 · 11:12
clinicalRecto vestibular fistula has three openings: the urethra, the vagina, and a fistula within the vestibule↗
▶Ep 98 · 12:22
clinicalUrogenital sinus plus a normal anus is an endocrine problem, but no anus and a urogenital sinus is a cloaca↗
▶Ep 98 · 15:03
clinicalIf there is only one orifice, this is a cloaca↗
▶Ep 98 · 15:03
clinicalThe biggest question with female anorectal malformation exam is how many perineal orifices are there↗
▶Ep 98 · 15:03
clinicalIf there are three orifices, the question is whether it is a perineal fistula or a vestibular fistula↗
▶Ep 98 · 15:03
clinicalIf there are two orifices, it is important to know if there is a fistula at all, vaginal atresia, or a rectal vaginal fistula↗
guidelineA cloaca or anorectal malformation is associated with VACTERL and needs to be worked up as such.↗
▶Ep 102 · 3:10
guidelineVACTERL association requires three or more anomalies: vertebral, imperforate anus, cardiovascular, tracheoesophageal fistula, esophageal atresia, renal/radial, and limb defects.↗
▶Ep 102 · 8:45
guidelineInitial workup should consist of an NG tube and chest X-ray, cardiac echo, and pelvic and renal ultrasound to assess for TEF, cardiac anomalies, hydrocolpos, and hydronephrosis.↗
▶Ep 102 · 9:10
guidelineIf a patient has bilateral hydronephrosis and hydrocolpos, the hydrocolpos needs to be managed as part of initial treatment.↗
Colorectal Quiz Episode 18: Cloaca Part 2
▶Ep 103 · 0:09
quoteHey there listeners, it's Amanda Jensen from Cincinnati Children's.↗
▶Ep 103 · 1:57
quoteThat was Dr. Richard Wood from Nationwide Children's Hospital.↗
▶Ep 103 · 13:57
quoteThat was Doctor Mark Levitt from Children's National.↗
The Colorectal Quiz Episode 22: Hirschsprung Disease - the Soiling Patient Part 1
▶Ep 109 · 0:04
quoteHey there listeners, it's Amanda Jensen from Riley Children's.↗
▶Ep 109 · 0:34
quoteThat was Doctor Jason Fisher from Cincinnati Children's.↗
▶Ep 109 · 0:53
quoteThat was Doctor Mark Levitt from Children's National.↗
▶Ep 109 · 11:38
quoteThat was Doctor Hira Ahmad from Seattle Children's.↗
The Colorectal Quiz Episode 23: Hirschsprung Disease - The Soiling Patient Part 2 -The Dentate Line and Motility
▶Ep 111 · 2:29
clinicalNighttime soiling with daytime control can occur if dentate line is lost with some preservation of external sphincter↗
Colorectal Quiz 25: Perineal Groove
▶Ep 114 · 5:12
clinicalA normal anus requires three qualities: location within the sphincter complex, adequate size, and presence of a perineal body↗
▶Ep 114 · 29:28
clinicalPerineal groove typically epithelializes by age 2 years without surgical intervention↗
Colorectal Quiz Episode 28: Female ARM Management - Perineal Fistula
▶Ep 119 · 3:02
clinicalA normal anus must be of appropriate size, in the center of the sphincter, and have a perineal body.↗
Colorectal Quiz Episode 18: Cloaca Part 2
▶Ep 237 · 0:00
quoteHey there listeners, it's Amanda Jensen from Cincinnati Children's.↗
▶Ep 237 · 6:26
clinicalThe common channel takes a very significant turn as it passes behind the pubis, particularly in longer common channel cases↗
▶Ep 237 · 6:26
quoteI think if you look at these pictures we have, you can see when we're looking at a lateral view, how the common channel actually takes a very significant turn as it gets behind the pubis.↗
▶Ep 237 · 6:45
clinicalCystoscopy significantly undermeasures anatomical structures compared to 3D reconstruction because the straight scope cannot accurately measure the turn behind the pubis↗
▶Ep 237 · 6:45
quoteWhat we found when we studied it was that the cystoscopy significantly undermeasures the structures when you scope and you compare the same patient's 3D reconstruction to their scope.↗
▶Ep 237 · 7:10
quoteYour straight scope can't measure that turn.↗
▶Ep 237 · 11:57
clinicalIf urethral length is less than 1.5 cm, urogenital separation is advocated because performing TUM would result in the bladder neck being sewn near the perineum, potentially rendering the patient incontinent↗
▶Ep 237 · 11:57
quoteIf the urethra is less than one and a half centimeters, we'd advocate for a urogenital separation. And the reason for that is if you were to do a TUM on a patient with a one centimeter urethra, and although these patients aren't common, they do exist, then you will have their bladder neck sewn right near the perineum. And that could render the patient incontinent.↗
▶Ep 237 · 13:08
clinicalWhen vagina or vaginas cannot reach the perineum, vaginal replacement may be needed to bridge the gap↗
Colorectal Quiz Episode 17: Cloaca Part 1
▶Ep 238 · 3:10
clinicalVACTERL association consists of vertebral anomalies, imperforate anus, cardiovascular anomalies, tracheoesophageal fistulas, esophageal atresia, renal or radial anomalies, and limb defects; three or more anomalies are needed for the association↗
▶Ep 238 · 11:45
quoteIf I look at my textbooks behind me, this is not written in the chapters written by people on this podcast of what to do for cloacas and hydrocolpos. So this is huge.↗
