Richard Wood

558 timestamped statements across 6 collections — auto-found in recorded discussions, each timestamp jumps to the exact moment.

Colorectal / ARM & Hirschsprung · guest expert Etiologies (Gastroschisis/NEC/Atresia/Volvulus) · guest expert Intestinal Rehab · guest expert

Featured diaries

▶ Ep 10 · 12:07
If the urethra is less than 1.5 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 1 centimeter urethra, and although these patients aren't common, they do exist, then you will have the bladder neck sewn right near the perineum, and that could render the patient incontinent.
quote · Cloaca
▶ Ep 103 · 12:07
If the urethra is less than 1.5 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 1 centimeter urethra, and although these patients aren't common, they do exist, then you will have the bladder neck sewn right near the perineum, and that could render the patient incontinent.
quote · Colorectal / ARM & Hirschsprung
▶ Ep 103 · 12:07
If the urethra is less than 1.5 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 1 centimeter urethra, and although these patients aren't common, they do exist, then you will have the bladder neck sewn right near the perineum, and that could render the patient incontinent.
quote · Colorectal / ARM & Hirschsprung
▶ Ep 10 · 19:20
That's what's difficult to measure really accurately with a cystoscope because you're around that curve that we can see in the picture. And so because you're around that curve behind the pubis in these longer ones where it's actually really important, you can seriously under and overread that and that's what that study that we did showed.
quote · Cloaca
▶ Ep 4 · 7:20
In a child with a cloacal malformation who does not have an anus, there really isn't an indication to investigate for ambiguae stenitalia or disorders of sexual differentiation. Because we know that these children with cloacas are female and they don't need that workup.
quote · Hydrocolpos
▶ Ep 4 · 7:20
In a child with a cloacal malformation who does not have an anus, there really isn't an indication to investigate for ambiguae stenitalia or disorders of sexual differentiation. Because we know that these children with cloacas are female and they don't need that workup.
quote · Hydrocolpos

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Cloaca 162 entries

Colorectal Quiz Episode 17: Cloaca Part 1

▶ Ep 9 · 2:05
clinical A single perineal orifice in a newborn indicates cloaca: the vagina, urethra, and rectum are fused internally into a single common channel. ↗
▶ Ep 9 · 2:15
quote The single perineal orifice should clue you into a cloaca. The vagina, urethra, and rectum are fused together inside, creating a single common channel. ↗
▶ Ep 9 · 2:31
clinical Hydrocolpos is distension of the vagina caused by accumulation of fluid. ↗
▶ Ep 9 · 3:44
epidemiological Prenatal diagnostic yield for cloacal malformations is still much lower than desired. ↗
▶ Ep 9 · 4:00
clinical Hydrocolpos on prenatal ultrasound should alert to the possibility of cloaca. ↗
▶ Ep 9 · 4:05
quote A hydrocolpos on a perinatal ultrasound should alert us to a possibility of a cloaca. ↗
▶ Ep 9 · 4:20
clinical Subtle prenatal signs of cloaca include abnormal kidneys (e.g., single kidney) and two-vessel cord. ↗
▶ Ep 9 · 6:19
quote I think the first thing you've got to do is do a really good exam with good lighting. ↗
▶ Ep 9 · 6:28
clinical Physical exam of cloaca perineum with good lighting and labial distraction reveals a clitoral hood, underdeveloped labia minora, a single perineal orifice, and a perineal groove suggesting muscle complex. ↗
▶ Ep 9 · 7:16
guideline In a child with cloacal malformation who does not have an anus, there is no indication to investigate for ambiguous genitalia or disorders of sexual differentiation; these children are female and do not need karyotyping. ↗
▶ Ep 9 · 7:16
quote In a child with a cloacal malformation who does not have an anus, there really isn't an indication to investigate for ambiguous genitalia or disorders of sexual differentiation, because we know that these children with cloacas are female and they don't need that workup. ↗
▶ Ep 9 · 7:56
guideline Initial urgent management priorities in cloaca are: ensure kidney and urine decompression, diagnose hydrocolpos, and confirm patient is safe for anesthesia (cardiac assessment, TEF screen). ↗
▶ Ep 9 · 9:10
quote Traditionally that was always in the form of vaginostomy. I think we've moved heavily away from doing vaginostomies and much more with doing CIC through the common channel. ↗
▶ Ep 9 · 9:22
guideline Modern practice has moved away from routine vaginostomy toward clean intermittent catheterization (CIC) through the common channel to drain hydrocolpos. ↗
▶ Ep 9 · 9:24
clinical CIC technique: pass a tube through the common channel, drain fluid, confirm by ultrasound that the tube is in the hydrocolpos/vagina, decompress it, and repeat catheterization regularly. If effective, proceed with colostomy and continue CIC postoperatively. ↗
▶ Ep 9 · 12:33
guideline After passing a catheter for hydrocolpos drainage, obtain bedside ultrasound immediately to confirm catheter position in the hydrocolpos and successful decompression. ↗
▶ Ep 9 · 15:01
guideline CIC frequency: initially three times daily in the NICU, then twice daily when families take over. Follow with serial ultrasounds every 2–3 days initially, then weekly, then monthly at home to confirm kidney decompression. ↗
▶ Ep 9 · 15:01
clinical The goal of hydrocolpos drainage is kidney decompression. If kidneys are completely normal despite hydrocolpos, the hydrocolpos is not urgent; if kidneys are obstructed, drainage is critical. ↗
▶ Ep 9 · 15:01
quote The most important thing is if you've got a hydrocolpos with completely normal kidneys, it doesn't matter. The important thing is that you're decompressing their kidneys. ↗
▶ Ep 9 · 16:20
guideline Even with a vaginostomy tube, serial ultrasound is required to confirm the tube is keeping kidneys decompressed; do not assume it is working without imaging confirmation. ↗
▶ Ep 9 · 16:40
quote However you drain the hydrocolpos, your job is to continue checking the kidneys are decompressed. ↗
▶ Ep 9 · 17:02
guideline Newborn cloaca management summary: good exam with lighting to diagnose, no endocrine workup needed, renal/pelvic ultrasound and anesthesia safety tests, drain hydrocolpos (preferably by CIC), and colostomy within 24–48 hours. ↗
▶ Ep 9 · 17:55
guideline Colostomy should be performed as proximally as possible—at the descending-sigmoid junction—to preserve distal bowel length for future reconstruction. ↗
▶ Ep 9 · 17:55
quote I would advocate for doing your colostomy as proximally as you can in this situation to make sure that you have enough length for distal work. So I'd probably do it at the descending sigmoid junction rather than sort of any lower down sigmoid. ↗
▶ Ep 9 · 18:42
clinical Laparoscopic colostomy in non-distended newborns offers excellent pelvic anatomic visualization, precise stoma site selection, and the ability to create a stoma without a skin bridge between proximal and distal limbs. ↗
▶ Ep 9 · 18:42
quote If the patient's not distended, I really do like to use the laparoscope for these newborn colostomy formation. ↗
▶ Ep 9 · 19:10
clinical Laparoscopic colostomy technique: mobilize lateral attachments of descending colon, bring bowel through mucus-fistula site, staple and washout distal limb until clean, then create separate incision for proximal stoma, leaving clean skin around working stoma and closing mucus-fistula site partially. ↗
▶ Ep 9 · 20:12
clinical If vaginostomy is required and the patient has a vaginal septum, open the anterior wall of the hydrocolpos and remove a small portion of the septum to drain both sides through one opening. ↗
▶ Ep 9 · 20:40
quote Prior to creating a vaginostomy, check if the patient has a septum or not because we may have to remove a part of the septum to adequately drain the vagina. ↗
▶ Ep 9 · 21:00
clinical Vaginostomy can be performed with or without a tube. Tubes can become encrusted and colonized, so tubeless (suturing vagina to abdominal wall) may be preferable if the vagina reaches the abdominal wall easily. ↗
▶ Ep 9 · 24:36
guideline Post-discharge follow-up for cloaca: monitor kidney decompression with serial ultrasounds, follow kidney function tests, ensure stoma management and growth. Definitive imaging and reconstructive planning are deferred until the patient is growing and thriving. ↗

Colorectal Quiz Episode 18: Cloaca Part 2

▶ Ep 10 · 1:53
quote So we usually do it at about 5 to 6 months. ↗
▶ Ep 10 · 1:53
clinical Definitive diagnostic workup for cloaca is typically performed at 5 to 6 months of age. ↗
▶ Ep 10 · 2:06
clinical The workup includes multidisciplinary team evaluation (urology, gynecology, colorectal), cystovaginoscopy and examination under anesthesia, preoperative urodynamics catheter placement, and 3D cloacogram. ↗
▶ Ep 10 · 2:50
clinical During cystoscopy of the common channel, the easiest structure to enter is the vagina or vaginas; entering the urethra and bladder is challenging because the scope must point far upward to take the turn. ↗
▶ Ep 10 · 2:50
quote The easiest structure to get into when you do a cystoscopy of the common channel is you usually go straight into the vagina or vaginas. It's actually quite challenging to get into the urethra and the bladder because you have to really point very far up to take that turn. ↗
▶ Ep 10 · 3:44
clinical The 3D cloacogram is acquired by injecting contrast into bladder, vagina(s), and rectal fistula, then using a vascular C-arm in radiology (or hybrid OR) with reconstruction software to create three-dimensional images. ↗
▶ Ep 10 · 4:13
quote The big advantage of the three-dimensional reconstruction, which we'll show here in a second, is that you can get a spatial understanding of what's going on because the patients, unfortunately, don't always read the textbooks. ↗
▶ Ep 10 · 4:13
opinion The major advantage of 3D reconstruction is spatial understanding of anatomy, because patients do not always present with textbook anatomy. ↗
▶ Ep 10 · 6:15
clinical The common channel takes a significant turn as it passes behind the pubis, especially in longer common channel cases. ↗
▶ Ep 10 · 6:15
quote 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, especially on these longer common channel cases. ↗
▶ Ep 10 · 6:36
quote What 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 10 · 6:36
clinical A multi-institutional study showed that cystoscopy significantly undermeasures common channel and urethral structures compared to 3D reconstruction, because a straight scope cannot measure the turn behind the pubis. ↗
▶ Ep 10 · 7:21
clinical Relying only on cystoscopy may result in significantly underreading the length of the common channel. ↗
▶ Ep 10 · 7:21
quote So what you'll end up doing is maybe not getting the most accurate view of what you're dealing with if you only use cystoscopy. So, it's fine if that's all you have, that's all you have, but just be aware that you may significantly underread the length of the common channel if you're doing it just with a scope. ↗
▶ Ep 10 · 9:20
clinical The algorithm published in 2017 ('Cloaca reconstruction: a new algorithm which considers the role of urethral length in determining surgical planning,' Journal of Pediatric Surgery) helps identify patients amenable to reproducible reconstruction vs. those needing complex reconstruction. ↗
▶ Ep 10 · 10:28
clinical Type 1 cloaca is defined as common channel length <1 cm; it is essentially a hypospadic urethra with a rectovaginal fistula. ↗
▶ Ep 10 · 10:28
quote If the common channel is less than 1 centimeter long, we would generally call that a type one cloaca. It's really a hypospadic urethra with a rectovaginal fistula. ↗
▶ Ep 10 · 10:57
quote In that situation, we don't touch the hyperspatic urethral orifice. And the plan here would be to do a vaginoplasty, and anorectoplasty, and a PSARP. ↗
▶ Ep 10 · 10:57
clinical In type 1 cloaca, the hypospadic urethral orifice is not touched; the plan is vaginoplasty, anorectoplasty, and PSARP. ↗
▶ Ep 10 · 11:17
clinical Even in type 1 cloaca, the true rectum can still be high, so imaging is important to determine rectal position. ↗
▶ Ep 10 · 11:17
quote I will say though, that the imaging in this case is really important because the true rectum can still be high even in a type 1 cloaca. ↗
▶ Ep 10 · 11:37
clinical For common channel length 1-3 cm, a normal urethra should be at least 1.5 cm long. ↗
▶ Ep 10 · 11:44
quote A normal urethra, we want to be at least 1.5 centimeters. ↗
▶ Ep 10 · 11:49
clinical If urethral length is >1.5 cm and common channel is 1-3 cm, the patient is amenable to total urogenital mobilization (TUM) and PSARP. ↗
▶ Ep 10 · 11:49
quote If the urethra is more than 1.5 centimeters, this would be amenable to a total urogenital mobilization and a PSARP. ↗
▶ Ep 10 · 12:07
quote If the urethra is less than 1.5 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 1 centimeter urethra, and although these patients aren't common, they do exist, then you will have the bladder neck sewn right near the perineum, and that could render the patient incontinent. ↗
▶ Ep 10 · 12:07
clinical If urethral length is <1.5 cm, urogenital separation (UGS) is advocated, because performing TUM on a 1 cm urethra would place the bladder neck near the perineum and could render the patient incontinent. ↗
▶ Ep 10 · 12:29
clinical The majority of 1-3 cm common channel cloacas have a normal length urethra and are amenable to TUM. ↗
▶ Ep 10 · 12:44
clinical For common channel >3 cm, patients often have urethral length <1.5 cm; in either case, UGS is advocated with repair of the common channel (left as the urethra), mobilization of the vagina to the perineum, and PSARP. ↗
▶ Ep 10 · 12:55
quote If either of those things are the case [common channel >3 cm or urethra <1.5 cm], then we would advocate for a urogenital separation and a repair of the common channel which we leave as the urethra, and mobilization of the vagina down to the perineum and a PSARP. ↗
▶ Ep 10 · 13:18
clinical If the vagina or vaginas cannot reach the perineum, the patient may need vaginal replacement to bridge the gap. ↗
▶ Ep 10 · 13:18
quote If the vagina or vaginas are unable to reach the perineum, then the patient may need a vaginal replacement in order to bridge the gap. ↗
▶ Ep 10 · 13:34
quote If the rectum is high, you may want to consider doing that with an abdominal approach to mobilize first. And so that may change your PSARP approach to a laparoscopic assisted PSARP in order to mobilize length. ↗
▶ Ep 10 · 13:34
clinical If the rectum is high, consider an abdominal approach (open or laparoscopic-assisted PSARP) to mobilize rectal length. ↗
▶ Ep 10 · 17:34
quote I will say that I was just relieved that Doctor Hendren didn't have a question for me, if I can be completely honest. ↗
▶ Ep 10 · 17:40
quote If you just stick to the algorithm, it really works. And we've looked at this, and I think it's now 116 patients in a row. And if you follow the algorithm, we haven't once had to change the plan. ↗
▶ Ep 10 · 17:52
clinical The algorithm has been validated in 116 consecutive patients without a single intraoperative plan change. ↗
▶ Ep 10 · 18:01
opinion Following the algorithm using the 3 cm and 1.5 cm thresholds allows surgeons to stay out of trouble; it provides a guide for which cases are reproducible and which require referral. ↗
▶ Ep 10 · 18:11
quote If you're not an experienced cloacal surgeon, it gives you a really good guide as to which ones are reproducible and which ones you might want to get help from a friend with. ↗
▶ Ep 10 · 19:09
clinical Urethral length is defined as the distance from where the common channel splits (urethra separates from vagina) to where the urethra enters the bladder, not from the single perineal orifice to the bladder neck. ↗
▶ Ep 10 · 19:09
quote What we mean is that it's when your common channel splits, it's the distance from where the urethra leaves the common channel to where it enters the bladder. ↗
▶ Ep 10 · 19:20
clinical Measuring urethral length accurately with a cystoscope is difficult because the scope must navigate the curve behind the pubis, leading to significant under- or over-reading; this is especially important in longer common channel cases. ↗
▶ Ep 10 · 19:20
quote That's what's difficult to measure really accurately with a cystoscope because you're around that curve that we can see in the picture. And so because you're around that curve behind the pubis in these longer ones where it's actually really important, you can seriously under and overread that and that's what that study that we did showed. ↗
▶ Ep 10 · 19:40
quote Getting an accurate measurement of the urethra is fundamentally important because what we want to do is land up with a bladder neck above the urogenital diaphragm, which is where the external sphincter or where the sphincter complex, the urethra lies. And also just then your intraabdominal pressure doesn't mess you up. ↗
▶ Ep 10 · 19:40
clinical The goal is to position the bladder neck above the urogenital diaphragm, where the external sphincter complex and urethra lie, so that intraabdominal pressure does not compromise continence. ↗
▶ Ep 10 · 19:59
clinical Urethral length can be measured using a ureteric catheter under fluoroscopy or with a scope, but the most accurate measurement comes from 3D imaging because it does not straighten structures and falsely measure them. ↗
▶ Ep 10 · 19:59
quote You can use a ureteric catheter, which you can watch and measure it that way, or you can measure it on your scope, but your most accurate measurement probably comes from your imaging because it's not straightening all the structures out and then falsely measuring them. ↗

Colorectal Quiz Episode 24: Cloaca Part 3

▶ Ep 11 · 3:47
epidemiological About 30 to 50% of children with cloacal malformations will develop long-term renal dysfunction. ↗
▶ Ep 11 · 10:28
clinical Lateral attachments posteriorly on the vagina, where the blood supply lies, represent an important safe plane for TUM mobilization. ↗
▶ Ep 11 · 10:52
clinical Full mobilization into the peritoneum is necessary to adequately release the rectum and visualize vaginal attachments during TUM. ↗
▶ Ep 11 · 10:52
quote You have to really go into the peritoneum with these releases because you've got to get the rectum out of the way to be able to mobilize the posterior vagina. ↗
▶ Ep 11 · 13:00
clinical For TUM, the common channel is opened widely until the urethral and vaginal openings are clearly visible, often requiring opening into the vagina. ↗
▶ Ep 11 · 13:49
clinical Remeasuring the common channel intraoperatively after opening it is important to confirm preoperative measurements and ensure TUM is still appropriate. ↗
▶ Ep 11 · 17:18
clinical For TUM, full-thickness lateral dissection is essential; inadequate dissection causes the common channel to fall apart and leaves poor tissue for suturing. ↗
▶ Ep 11 · 17:43
clinical The common channel should be divided approximately 0.5 centimeters behind the clitoral tissue to avoid damaging nerve supply. ↗
▶ Ep 11 · 18:19
quote I think it's important also to keep feeling where the pubis is. So you make sure you get to the bottom of the pubis where the suspensory ligaments start. ↗
▶ Ep 11 · 18:49
quote I don't think you always have to go to the space of Rhetsius in order to get an adequate TUM without tension. I think sometimes you can do the lower suspensory ligaments and you're reaching tension-free, and I think it's fine at that point to just do a partial TUM. ↗
▶ Ep 11 · 23:43
clinical When the vagina is the most posterior structure in a cloacal malformation, it is often stuck to the presacral fascia and more difficult to mobilize than the rectum. ↗
▶ Ep 11 · 28:49
clinical In higher common channel cases, the ureters often come quite close to the bladder neck, requiring careful mapping during surgery. ↗
▶ Ep 11 · 29:11
clinical Once dissection reaches within 0.5 centimeters of where the ureters are, no more separation should be done safely from the posterior sagittal approach. ↗
▶ Ep 11 · 29:45
clinical Placing ureteric stents via cystoscopy prior to laparoscopic separation provides reassurance about ureter location during dissection. ↗
▶ Ep 11 · 30:55
clinical During laparoscopic separation, scissors with minimal or no cautery are used for the actual separation to avoid thermal injury to the urethra. ↗
▶ Ep 11 · 31:20
clinical Laparoscopic dissection appears to result in fewer vaginal replacements, possibly due to better visualization deep in the pelvis. ↗
▶ Ep 11 · 31:39
clinical Vaginal length is the most significant predictor of need for vaginal replacement; vaginas less than 4 cm are much more likely to need replacement, while those over 6 cm are much less likely. ↗
▶ Ep 11 · 32:39
quote Once you're through in the midline, you can very carefully work laterally and make sure you can see the ureters so we don't injure them. ↗
▶ Ep 11 · 32:53
clinical After implementing double-layer urethral repair with SIS and fat pad interposition, no urethrovaginal fistulas have occurred in 5.5 years. ↗
▶ Ep 11 · 34:16
clinical The vagina tends to envelop the bladder neck during separation, unlike the rectum in male repairs which stays in its lane, requiring careful circumferential dissection. ↗
▶ Ep 11 · 34:16
quote The vagina tends to sort of envelop the bladder neck a little bit. And so it often sort of wraps around it. And you have to be pretty careful when you're doing the separation that you keep working around it and making sure you're not getting into the bladder neck. ↗
▶ Ep 11 · 37:24
quote If you use this protocol and you repair the urethra without opening the common channel, We were able to have 97% of patients have a catheterizable urethra. ↗
▶ Ep 11 · 37:24
clinical Using the protocol with preserved common channel, 97% of patients maintain a catheterizable urethra. ↗
▶ Ep 11 · 37:40
opinion Maintaining perineal access to the bladder is valuable even if a Mitrofanoff is eventually needed, as it provides a pop-off that allows patients to empty. ↗

Colorectal Quiz Episode 18: Cloaca Part 2

▶ Ep 20 · 1:56
clinical The workup includes multidisciplinary team evaluation (urology, gynecology, colorectal) followed by cystovaginoscopy and examination under anesthesia ↗
▶ Ep 20 · 2:31
clinical Preoperative urodynamics catheter is placed in the bladder as part of the examination ↗
▶ Ep 20 · 3:08
quote What's the first structure that you encounter when doing a common channel scope? And as Mark said, the easiest structure to get into when you do a cystoscopy of the common channel is you usually go straight into the vagina or vaginas. ↗
▶ Ep 20 · 3:08
clinical During cystoscopy of the common channel, the easiest structure to enter is usually the vagina or vaginas; entering the urethra and bladder is challenging because it requires pointing very far up ↗
▶ Ep 20 · 3:30
quote It's actually quite challenging to get into the urethra and the bladder because you have to really point very far up to take that turn. ↗
▶ Ep 20 · 3:30
clinical During endoscopy, surgeons measure the length of the urethra, common channel, and vagina, and assess for the presence of a septum and location of the rectal fistula ↗
▶ Ep 20 · 4:00
clinical 3D cloacogram is acquired by injecting contrast into all three structures (urethra, vagina, rectum) and using vascular C-arm software to reconstruct three-dimensional images ↗
▶ Ep 20 · 10:07
clinical For common channel less than 1 cm (type one cloaca), the malformation is essentially a hypospadiac urethra with a rectovaginal fistula ↗
▶ Ep 20 · 10:20
quote If the common channel is less than a centimeter long, we would generally call that a type one cloaca. It's really a hypospatic urethra with a rectovaginal fistula. ↗
▶ Ep 20 · 10:40
clinical In type one cloaca (common channel <1 cm), the hypospadiac urethral orifice is not touched, and the plan is vaginoplasty, introitoplasty, and PSARP ↗
▶ Ep 20 · 11:10
clinical Even in type one cloaca with short common channel, the true rectum can still be high, so knowing rectal height is important ↗
▶ Ep 20 · 11:30
clinical A normal urethra should be at least 1.5 cm in length ↗
▶ Ep 20 · 11:30
quote So a normal urethra, we want to be at least one and a half centimeters. ↗
▶ Ep 20 · 11:40
clinical For common channel 1-3 cm with urethral length >1.5 cm, the patient is amenable to total urogenital mobilization (TUM) and PSARP ↗
▶ Ep 20 · 12:46
clinical For common channel >3 cm, patients often have urethral length <1.5 cm, and urogenital separation with repair of the common channel as the urethra is advocated ↗
▶ Ep 20 · 13:32
clinical If the rectum is high, surgeons may want to consider an abdominal approach to mobilize first, changing the PSARP approach to LARP (laparoscopic-assisted PSARP) ↗
▶ Ep 20 · 17:36
clinical Following the algorithm, 116 consecutive patients have been managed without needing to change the surgical plan ↗
▶ Ep 20 · 17:50
quote I think it's now 116 patients in a row. And if you follow the algorithm, we haven't once had to change the plan. ↗
▶ Ep 20 · 19:09
clinical Urethral length is defined as the distance from where the common channel splits (where urethra leaves the common channel) to where it enters the bladder, not from the single orifice to the bladder neck ↗
▶ Ep 20 · 19:09
quote What we mean is that it's when your common channel splits, it's the distance from where the urethra leaves the common channel to where it enters the bladder and so that's what's difficult to measure really accurately with a cystoscope because you're around that curve that we can see in the picture. ↗
▶ Ep 20 · 19:40
clinical Measuring urethral length accurately with cystoscopy is difficult because of the curve behind the pubis, which can lead to significant under- and over-reading ↗
▶ Ep 20 · 20:00
quote What we want to do is land up with a bladder neck above the urogenital diaphragm which is where the external sphincter or where the sphincter complex of the urethra lies and also just then your intra-abdominal pressure doesn't mess you up. ↗
▶ Ep 20 · 20:10
clinical The goal is to position the bladder neck above the urogenital diaphragm where the external sphincter complex lies, so that intra-abdominal pressure does not compromise continence ↗
▶ Ep 20 · 20:20
clinical The most accurate urethral measurement comes from 3D imaging rather than cystoscopy because imaging does not straighten the structures and falsely measure them ↗

Colorectal Quiz Episode 17: Cloaca Part 1

▶ Ep 21 · 2:05
clinical A single perineal orifice in a newborn indicates cloaca, where the vagina, urethra, and rectum are fused together inside creating a single common channel. ↗
▶ Ep 21 · 2:05
quote The single perineal orifice should clue you into a cloaca. The vagina, urethra, and rectum are fused together inside, creating a single common channel. ↗
▶ Ep 21 · 2:25
clinical Hydrocolpos is the distension of the vagina caused by accumulation of fluid. ↗
▶ Ep 21 · 2:45
guideline Cloaca or anorectal malformation is associated with VACTERL and needs to be worked up as such. ↗
▶ Ep 21 · 2:45
quote The key point here is that a cloaca or an anal rectal malformation is associated with bacterial and needs to be worked up as such. ↗
▶ Ep 21 · 3:44
epidemiological The diagnostic yield for cloaca on prenatal ultrasound is still much lower than desired. ↗
▶ Ep 21 · 4:00
clinical Hydrocolpos on prenatal ultrasound should alert to the possibility of cloaca. ↗
▶ Ep 21 · 4:00
quote A hydrocorpus on a prenatal ultrasound should alert us to a possibility of a cloaca. ↗
▶ Ep 21 · 4:12
clinical Prenatal findings suggestive of cloaca include abnormal kidneys, single kidney, and two-vessel cord association. ↗
▶ Ep 21 · 6:19
clinical Good physical exam with good lighting is the first step in evaluating suspected cloaca. ↗
▶ Ep 21 · 6:28
clinical On exam, distracting the labia reveals more of a clitoral hood than real labia minora, with a single perineal orifice posterior to the clitoral hood. ↗
▶ Ep 21 · 6:40
clinical A perineal groove behind the labia structures and dimpling representing muscle complex suggests the perineum is not completely flat. ↗
▶ Ep 21 · 7:20
guideline Children with cloacal malformation who do not have an anus do not need investigation for ambiguous genitalia or disorders of sexual differentiation because they are known to be female. ↗
▶ Ep 21 · 7:20
quote In a child with a cloacal malformation who does not have an anus, there really isn't an indication to investigate for ambiguae stenitalia or disorders of sexual differentiation. Because we know that these children with cloacas are female and they don't need that workup. ↗
▶ Ep 21 · 7:56
guideline Initial urgent management priorities are ensuring kidney decompression/urine drainage, diagnosing hydrocolpos, and confirming safety for OR (ruling out TEF and cardiac issues). ↗
▶ Ep 21 · 8:30
guideline Initial workup should consist of NG tube and chest x-ray, cardiac echo, and pelvic and renal ultrasound to assess for TEF, cardiac anomalies, hydrocolpos, and hydronephrosis. ↗
▶ Ep 21 · 8:50
clinical Bilateral hydronephrosis with hydrocolpos requires management of the hydrocolpos as part of initial treatment. ↗
▶ Ep 21 · 9:11
guideline The modern approach has moved heavily away from vaginostomy toward clean intermittent catheterization through the common channel for hydrocolpos drainage. ↗
▶ Ep 21 · 9:11
quote We've moved heavily away from doing vaginostomies and much more with doing CIC through the common channel. ↗
▶ Ep 21 · 9:24
clinical To perform CIC for hydrocolpos, pass a tube through the common channel, drain fluid, get ultrasound to confirm the tube is in the hydrocolpos/vagina, confirm decompression, then continue recurrently. ↗
▶ Ep 21 · 9:55
guideline If CIC effectively drains the hydrocolpos, proceed with colostomy only and continue drainage postoperatively; if unsuccessful, can return to formal vaginostomy. ↗
▶ Ep 21 · 12:33
guideline To confirm proper catheter placement, pass the tube, leave it in, get bedside ultrasound within first 24 hours to confirm it's in the hydrocolpos and decompressing it. ↗
▶ Ep 21 · 15:01
guideline Catheterization frequency is typically three times daily initially, then twice daily when family takes over, with serial ultrasounds every 2-3 days initially, then weekly, then monthly after discharge. ↗
▶ Ep 21 · 15:01
clinical The most important measure of successful hydrocolpos drainage is kidney decompression, not the hydrocolpos itself; if kidneys are completely normal, the hydrocolpos doesn't matter. ↗
▶ Ep 21 · 15:01
quote If you've got a hydrocopos with completely normal kidneys, it doesn't matter. The important thing is that you're decompressing their kidneys. ↗
▶ Ep 21 · 16:20
guideline Even with vaginostomy tubes, you must continue checking that kidneys remain decompressed; don't assume the tube is doing its job without verification. ↗
▶ Ep 21 · 16:40
quote The message to everyone is, however you drain the hydroculpus, your job is to continue checking the kidneys are decompressed. ↗
▶ Ep 21 · 17:02
guideline Newborn management bullet points: good exam with good light to diagnose, no endocrine workup for cloaca, renal/pelvic ultrasound plus tests for anesthesia safety, drain hydrocolpos by CIC, and colostomy within 24-48 hours. ↗
▶ Ep 21 · 17:53
guideline Colostomy should be done as proximally as possible (descending-sigmoid junction) to ensure enough length for distal work, rather than lower sigmoid. ↗
▶ Ep 21 · 17:53
quote I would advocate for doing your colostomy as proximally as you can in this situation to make sure that you have enough length for distal work. So I'd probably do it at the descending sigmoid junction rather than sort of any lower down sigmoid. ↗
▶ Ep 21 · 18:42
clinical Laparoscopy for newborn colostomy in non-distended patients provides good pelvic anatomy visualization, allows precise colostomy site selection, and avoids wound between stomas. ↗
▶ Ep 21 · 19:25
clinical Laparoscopic technique: mobilize lateral attachments of descending colon, bring bowel up through mucous fistula site, staple it, wash out distal limb completely, then make separate incision for proximal stoma with no surrounding incision for clean skin and easy bagging. ↗
▶ Ep 21 · 20:15
clinical For vaginostomy in patients with vaginal septum, open the anterior wall of the hydrocolpos vagina and remove a small portion of septum to drain both sides through one hole. ↗
▶ Ep 21 · 20:45
opinion Vaginostomy can be done with or without tubes; tubes can become encrusted and colonized, so tubeless has some advantage if anatomy allows easy reach to abdominal wall. ↗
▶ Ep 21 · 24:36
guideline Post-discharge follow-up focuses on ensuring kidneys are well decompressed, patient is growing well, following kidney function tests, and ensuring parents manage stoma effectively. ↗
▶ Ep 21 · 25:20
clinical With effective urine and stool drainage, patients should be thriving unless other underlying issues exist. ↗
Colorectal / ARM & Hirschsprung 306 entries

Colorectal Quiz Episode 17: Cloaca Part 1

▶ Ep 102 · 2:05
clinical A single perineal orifice in a newborn indicates cloaca: the vagina, urethra, and rectum are fused internally into a single common channel. ↗
▶ Ep 102 · 2:05
clinical A single perineal orifice in a newborn indicates cloaca: the vagina, urethra, and rectum are fused internally into a single common channel. ↗
▶ Ep 102 · 2:15
quote The single perineal orifice should clue you into a cloaca. The vagina, urethra, and rectum are fused together inside, creating a single common channel. ↗
▶ Ep 102 · 2:15
quote The single perineal orifice should clue you into a cloaca. The vagina, urethra, and rectum are fused together inside, creating a single common channel. ↗
▶ Ep 102 · 2:31
clinical Hydrocolpos is distension of the vagina caused by accumulation of fluid. ↗
▶ Ep 102 · 2:31
clinical Hydrocolpos is distension of the vagina caused by accumulation of fluid. ↗
▶ Ep 102 · 3:44
epidemiological Prenatal diagnostic yield for cloacal malformations is still much lower than desired. ↗
▶ Ep 102 · 3:44
epidemiological Prenatal diagnostic yield for cloacal malformations is still much lower than desired. ↗
▶ Ep 102 · 4:00
clinical Hydrocolpos on prenatal ultrasound should alert to the possibility of cloaca. ↗
▶ Ep 102 · 4:00
clinical Hydrocolpos on prenatal ultrasound should alert to the possibility of cloaca. ↗
▶ Ep 102 · 4:05
quote A hydrocolpos on a perinatal ultrasound should alert us to a possibility of a cloaca. ↗
▶ Ep 102 · 4:05
quote A hydrocolpos on a perinatal ultrasound should alert us to a possibility of a cloaca. ↗
▶ Ep 102 · 4:20
clinical Subtle prenatal signs of cloaca include abnormal kidneys (e.g., single kidney) and two-vessel cord. ↗
▶ Ep 102 · 4:20
clinical Subtle prenatal signs of cloaca include abnormal kidneys (e.g., single kidney) and two-vessel cord. ↗
▶ Ep 102 · 6:19
quote I think the first thing you've got to do is do a really good exam with good lighting. ↗
▶ Ep 102 · 6:19
quote I think the first thing you've got to do is do a really good exam with good lighting. ↗
▶ Ep 102 · 6:28
clinical Physical exam of cloaca perineum with good lighting and labial distraction reveals a clitoral hood, underdeveloped labia minora, a single perineal orifice, and a perineal groove suggesting muscle complex. ↗
▶ Ep 102 · 6:28
clinical Physical exam of cloaca perineum with good lighting and labial distraction reveals a clitoral hood, underdeveloped labia minora, a single perineal orifice, and a perineal groove suggesting muscle complex. ↗
▶ Ep 102 · 7:16
guideline In a child with cloacal malformation who does not have an anus, there is no indication to investigate for ambiguous genitalia or disorders of sexual differentiation; these children are female and do not need karyotyping. ↗
▶ Ep 102 · 7:16
quote In a child with a cloacal malformation who does not have an anus, there really isn't an indication to investigate for ambiguous genitalia or disorders of sexual differentiation, because we know that these children with cloacas are female and they don't need that workup. ↗
▶ Ep 102 · 7:16
guideline In a child with cloacal malformation who does not have an anus, there is no indication to investigate for ambiguous genitalia or disorders of sexual differentiation; these children are female and do not need karyotyping. ↗
▶ Ep 102 · 7:16
quote In a child with a cloacal malformation who does not have an anus, there really isn't an indication to investigate for ambiguous genitalia or disorders of sexual differentiation, because we know that these children with cloacas are female and they don't need that workup. ↗
▶ Ep 102 · 7:56
guideline Initial urgent management priorities in cloaca are: ensure kidney and urine decompression, diagnose hydrocolpos, and confirm patient is safe for anesthesia (cardiac assessment, TEF screen). ↗
▶ Ep 102 · 7:56
guideline Initial urgent management priorities in cloaca are: ensure kidney and urine decompression, diagnose hydrocolpos, and confirm patient is safe for anesthesia (cardiac assessment, TEF screen). ↗
▶ Ep 102 · 9:10
quote Traditionally that was always in the form of vaginostomy. I think we've moved heavily away from doing vaginostomies and much more with doing CIC through the common channel. ↗
▶ Ep 102 · 9:10
quote Traditionally that was always in the form of vaginostomy. I think we've moved heavily away from doing vaginostomies and much more with doing CIC through the common channel. ↗
▶ Ep 102 · 9:22
guideline Modern practice has moved away from routine vaginostomy toward clean intermittent catheterization (CIC) through the common channel to drain hydrocolpos. ↗
▶ Ep 102 · 9:22
guideline Modern practice has moved away from routine vaginostomy toward clean intermittent catheterization (CIC) through the common channel to drain hydrocolpos. ↗
▶ Ep 102 · 9:24
clinical CIC technique: pass a tube through the common channel, drain fluid, confirm by ultrasound that the tube is in the hydrocolpos/vagina, decompress it, and repeat catheterization regularly. If effective, proceed with colostomy and continue CIC postoperatively. ↗
▶ Ep 102 · 9:24
clinical CIC technique: pass a tube through the common channel, drain fluid, confirm by ultrasound that the tube is in the hydrocolpos/vagina, decompress it, and repeat catheterization regularly. If effective, proceed with colostomy and continue CIC postoperatively. ↗
▶ Ep 102 · 12:33
guideline After passing a catheter for hydrocolpos drainage, obtain bedside ultrasound immediately to confirm catheter position in the hydrocolpos and successful decompression. ↗
▶ Ep 102 · 12:33
guideline After passing a catheter for hydrocolpos drainage, obtain bedside ultrasound immediately to confirm catheter position in the hydrocolpos and successful decompression. ↗
▶ Ep 102 · 15:01
clinical The goal of hydrocolpos drainage is kidney decompression. If kidneys are completely normal despite hydrocolpos, the hydrocolpos is not urgent; if kidneys are obstructed, drainage is critical. ↗
▶ Ep 102 · 15:01
guideline CIC frequency: initially three times daily in the NICU, then twice daily when families take over. Follow with serial ultrasounds every 2–3 days initially, then weekly, then monthly at home to confirm kidney decompression. ↗
▶ Ep 102 · 15:01
guideline CIC frequency: initially three times daily in the NICU, then twice daily when families take over. Follow with serial ultrasounds every 2–3 days initially, then weekly, then monthly at home to confirm kidney decompression. ↗
▶ Ep 102 · 15:01
clinical The goal of hydrocolpos drainage is kidney decompression. If kidneys are completely normal despite hydrocolpos, the hydrocolpos is not urgent; if kidneys are obstructed, drainage is critical. ↗
▶ Ep 102 · 15:01
quote The most important thing is if you've got a hydrocolpos with completely normal kidneys, it doesn't matter. The important thing is that you're decompressing their kidneys. ↗
▶ Ep 102 · 15:01
quote The most important thing is if you've got a hydrocolpos with completely normal kidneys, it doesn't matter. The important thing is that you're decompressing their kidneys. ↗
▶ Ep 102 · 16:20
guideline Even with a vaginostomy tube, serial ultrasound is required to confirm the tube is keeping kidneys decompressed; do not assume it is working without imaging confirmation. ↗
▶ Ep 102 · 16:20
guideline Even with a vaginostomy tube, serial ultrasound is required to confirm the tube is keeping kidneys decompressed; do not assume it is working without imaging confirmation. ↗
▶ Ep 102 · 16:40
quote However you drain the hydrocolpos, your job is to continue checking the kidneys are decompressed. ↗
▶ Ep 102 · 16:40
quote However you drain the hydrocolpos, your job is to continue checking the kidneys are decompressed. ↗
▶ Ep 102 · 17:02
guideline Newborn cloaca management summary: good exam with lighting to diagnose, no endocrine workup needed, renal/pelvic ultrasound and anesthesia safety tests, drain hydrocolpos (preferably by CIC), and colostomy within 24–48 hours. ↗
▶ Ep 102 · 17:02
guideline Newborn cloaca management summary: good exam with lighting to diagnose, no endocrine workup needed, renal/pelvic ultrasound and anesthesia safety tests, drain hydrocolpos (preferably by CIC), and colostomy within 24–48 hours. ↗
▶ Ep 102 · 17:55
quote I would advocate for doing your colostomy as proximally as you can in this situation to make sure that you have enough length for distal work. So I'd probably do it at the descending sigmoid junction rather than sort of any lower down sigmoid. ↗
▶ Ep 102 · 17:55
guideline Colostomy should be performed as proximally as possible—at the descending-sigmoid junction—to preserve distal bowel length for future reconstruction. ↗
▶ Ep 102 · 17:55
guideline Colostomy should be performed as proximally as possible—at the descending-sigmoid junction—to preserve distal bowel length for future reconstruction. ↗
▶ Ep 102 · 17:55
quote I would advocate for doing your colostomy as proximally as you can in this situation to make sure that you have enough length for distal work. So I'd probably do it at the descending sigmoid junction rather than sort of any lower down sigmoid. ↗
▶ Ep 102 · 18:42
clinical Laparoscopic colostomy in non-distended newborns offers excellent pelvic anatomic visualization, precise stoma site selection, and the ability to create a stoma without a skin bridge between proximal and distal limbs. ↗
▶ Ep 102 · 18:42
clinical Laparoscopic colostomy in non-distended newborns offers excellent pelvic anatomic visualization, precise stoma site selection, and the ability to create a stoma without a skin bridge between proximal and distal limbs. ↗
▶ Ep 102 · 18:42
quote If the patient's not distended, I really do like to use the laparoscope for these newborn colostomy formation. ↗
▶ Ep 102 · 18:42
quote If the patient's not distended, I really do like to use the laparoscope for these newborn colostomy formation. ↗
▶ Ep 102 · 19:10
clinical Laparoscopic colostomy technique: mobilize lateral attachments of descending colon, bring bowel through mucus-fistula site, staple and washout distal limb until clean, then create separate incision for proximal stoma, leaving clean skin around working stoma and closing mucus-fistula site partially. ↗
▶ Ep 102 · 19:10
clinical Laparoscopic colostomy technique: mobilize lateral attachments of descending colon, bring bowel through mucus-fistula site, staple and washout distal limb until clean, then create separate incision for proximal stoma, leaving clean skin around working stoma and closing mucus-fistula site partially. ↗
▶ Ep 102 · 20:12
clinical If vaginostomy is required and the patient has a vaginal septum, open the anterior wall of the hydrocolpos and remove a small portion of the septum to drain both sides through one opening. ↗
▶ Ep 102 · 20:12
clinical If vaginostomy is required and the patient has a vaginal septum, open the anterior wall of the hydrocolpos and remove a small portion of the septum to drain both sides through one opening. ↗
▶ Ep 102 · 20:40
quote Prior to creating a vaginostomy, check if the patient has a septum or not because we may have to remove a part of the septum to adequately drain the vagina. ↗
▶ Ep 102 · 20:40
quote Prior to creating a vaginostomy, check if the patient has a septum or not because we may have to remove a part of the septum to adequately drain the vagina. ↗
▶ Ep 102 · 21:00
clinical Vaginostomy can be performed with or without a tube. Tubes can become encrusted and colonized, so tubeless (suturing vagina to abdominal wall) may be preferable if the vagina reaches the abdominal wall easily. ↗
▶ Ep 102 · 21:00
clinical Vaginostomy can be performed with or without a tube. Tubes can become encrusted and colonized, so tubeless (suturing vagina to abdominal wall) may be preferable if the vagina reaches the abdominal wall easily. ↗
▶ Ep 102 · 24:36
guideline Post-discharge follow-up for cloaca: monitor kidney decompression with serial ultrasounds, follow kidney function tests, ensure stoma management and growth. Definitive imaging and reconstructive planning are deferred until the patient is growing and thriving. ↗
▶ Ep 102 · 24:36
guideline Post-discharge follow-up for cloaca: monitor kidney decompression with serial ultrasounds, follow kidney function tests, ensure stoma management and growth. Definitive imaging and reconstructive planning are deferred until the patient is growing and thriving. ↗

Colorectal Quiz Episode 18: Cloaca Part 2

▶ Ep 103 · 1:53
clinical Definitive diagnostic workup for cloaca is typically performed at 5 to 6 months of age. ↗
▶ Ep 103 · 1:53
clinical Definitive diagnostic workup for cloaca is typically performed at 5 to 6 months of age. ↗
▶ Ep 103 · 1:53
quote So we usually do it at about 5 to 6 months. ↗
▶ Ep 103 · 1:53
quote So we usually do it at about 5 to 6 months. ↗
▶ Ep 103 · 2:06
clinical The workup includes multidisciplinary team evaluation (urology, gynecology, colorectal), cystovaginoscopy and examination under anesthesia, preoperative urodynamics catheter placement, and 3D cloacogram. ↗
▶ Ep 103 · 2:06
clinical The workup includes multidisciplinary team evaluation (urology, gynecology, colorectal), cystovaginoscopy and examination under anesthesia, preoperative urodynamics catheter placement, and 3D cloacogram. ↗
▶ Ep 103 · 2:50
clinical During cystoscopy of the common channel, the easiest structure to enter is the vagina or vaginas; entering the urethra and bladder is challenging because the scope must point far upward to take the turn. ↗
▶ Ep 103 · 2:50
quote The easiest structure to get into when you do a cystoscopy of the common channel is you usually go straight into the vagina or vaginas. It's actually quite challenging to get into the urethra and the bladder because you have to really point very far up to take that turn. ↗
▶ Ep 103 · 2:50
clinical During cystoscopy of the common channel, the easiest structure to enter is the vagina or vaginas; entering the urethra and bladder is challenging because the scope must point far upward to take the turn. ↗
▶ Ep 103 · 2:50
quote The easiest structure to get into when you do a cystoscopy of the common channel is you usually go straight into the vagina or vaginas. It's actually quite challenging to get into the urethra and the bladder because you have to really point very far up to take that turn. ↗
▶ Ep 103 · 3:44
clinical The 3D cloacogram is acquired by injecting contrast into bladder, vagina(s), and rectal fistula, then using a vascular C-arm in radiology (or hybrid OR) with reconstruction software to create three-dimensional images. ↗
▶ Ep 103 · 3:44
clinical The 3D cloacogram is acquired by injecting contrast into bladder, vagina(s), and rectal fistula, then using a vascular C-arm in radiology (or hybrid OR) with reconstruction software to create three-dimensional images. ↗
▶ Ep 103 · 4:13
opinion The major advantage of 3D reconstruction is spatial understanding of anatomy, because patients do not always present with textbook anatomy. ↗
▶ Ep 103 · 4:13
opinion The major advantage of 3D reconstruction is spatial understanding of anatomy, because patients do not always present with textbook anatomy. ↗
▶ Ep 103 · 4:13
quote The big advantage of the three-dimensional reconstruction, which we'll show here in a second, is that you can get a spatial understanding of what's going on because the patients, unfortunately, don't always read the textbooks. ↗
▶ Ep 103 · 4:13
quote The big advantage of the three-dimensional reconstruction, which we'll show here in a second, is that you can get a spatial understanding of what's going on because the patients, unfortunately, don't always read the textbooks. ↗
▶ Ep 103 · 6:15
quote 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, especially on these longer common channel cases. ↗
▶ Ep 103 · 6:15
quote 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, especially on these longer common channel cases. ↗
▶ Ep 103 · 6:15
clinical The common channel takes a significant turn as it passes behind the pubis, especially in longer common channel cases. ↗
▶ Ep 103 · 6:15
clinical The common channel takes a significant turn as it passes behind the pubis, especially in longer common channel cases. ↗
▶ Ep 103 · 6:36
quote What 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 103 · 6:36
clinical A multi-institutional study showed that cystoscopy significantly undermeasures common channel and urethral structures compared to 3D reconstruction, because a straight scope cannot measure the turn behind the pubis. ↗
▶ Ep 103 · 6:36
clinical A multi-institutional study showed that cystoscopy significantly undermeasures common channel and urethral structures compared to 3D reconstruction, because a straight scope cannot measure the turn behind the pubis. ↗
▶ Ep 103 · 6:36
quote What 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 103 · 7:21
quote So what you'll end up doing is maybe not getting the most accurate view of what you're dealing with if you only use cystoscopy. So, it's fine if that's all you have, that's all you have, but just be aware that you may significantly underread the length of the common channel if you're doing it just with a scope. ↗
▶ Ep 103 · 7:21
clinical Relying only on cystoscopy may result in significantly underreading the length of the common channel. ↗
▶ Ep 103 · 7:21
quote So what you'll end up doing is maybe not getting the most accurate view of what you're dealing with if you only use cystoscopy. So, it's fine if that's all you have, that's all you have, but just be aware that you may significantly underread the length of the common channel if you're doing it just with a scope. ↗
▶ Ep 103 · 7:21
clinical Relying only on cystoscopy may result in significantly underreading the length of the common channel. ↗
▶ Ep 103 · 9:20
clinical The algorithm published in 2017 ('Cloaca reconstruction: a new algorithm which considers the role of urethral length in determining surgical planning,' Journal of Pediatric Surgery) helps identify patients amenable to reproducible reconstruction vs. those needing complex reconstruction. ↗
▶ Ep 103 · 9:20
clinical The algorithm published in 2017 ('Cloaca reconstruction: a new algorithm which considers the role of urethral length in determining surgical planning,' Journal of Pediatric Surgery) helps identify patients amenable to reproducible reconstruction vs. those needing complex reconstruction. ↗
▶ Ep 103 · 10:28
clinical Type 1 cloaca is defined as common channel length <1 cm; it is essentially a hypospadic urethra with a rectovaginal fistula. ↗
▶ Ep 103 · 10:28
quote If the common channel is less than 1 centimeter long, we would generally call that a type one cloaca. It's really a hypospadic urethra with a rectovaginal fistula. ↗
▶ Ep 103 · 10:28
clinical Type 1 cloaca is defined as common channel length <1 cm; it is essentially a hypospadic urethra with a rectovaginal fistula. ↗
▶ Ep 103 · 10:28
quote If the common channel is less than 1 centimeter long, we would generally call that a type one cloaca. It's really a hypospadic urethra with a rectovaginal fistula. ↗
▶ Ep 103 · 10:57
quote In that situation, we don't touch the hyperspatic urethral orifice. And the plan here would be to do a vaginoplasty, and anorectoplasty, and a PSARP. ↗
▶ Ep 103 · 10:57
clinical In type 1 cloaca, the hypospadic urethral orifice is not touched; the plan is vaginoplasty, anorectoplasty, and PSARP. ↗
▶ Ep 103 · 10:57
quote In that situation, we don't touch the hyperspatic urethral orifice. And the plan here would be to do a vaginoplasty, and anorectoplasty, and a PSARP. ↗
▶ Ep 103 · 10:57
clinical In type 1 cloaca, the hypospadic urethral orifice is not touched; the plan is vaginoplasty, anorectoplasty, and PSARP. ↗
▶ Ep 103 · 11:17
clinical Even in type 1 cloaca, the true rectum can still be high, so imaging is important to determine rectal position. ↗
▶ Ep 103 · 11:17
quote I will say though, that the imaging in this case is really important because the true rectum can still be high even in a type 1 cloaca. ↗
▶ Ep 103 · 11:17
clinical Even in type 1 cloaca, the true rectum can still be high, so imaging is important to determine rectal position. ↗
▶ Ep 103 · 11:17
quote I will say though, that the imaging in this case is really important because the true rectum can still be high even in a type 1 cloaca. ↗
▶ Ep 103 · 11:37
clinical For common channel length 1-3 cm, a normal urethra should be at least 1.5 cm long. ↗
▶ Ep 103 · 11:37
clinical For common channel length 1-3 cm, a normal urethra should be at least 1.5 cm long. ↗
▶ Ep 103 · 11:44
quote A normal urethra, we want to be at least 1.5 centimeters. ↗
▶ Ep 103 · 11:44
quote A normal urethra, we want to be at least 1.5 centimeters. ↗
▶ Ep 103 · 11:49
quote If the urethra is more than 1.5 centimeters, this would be amenable to a total urogenital mobilization and a PSARP. ↗
▶ Ep 103 · 11:49
clinical If urethral length is >1.5 cm and common channel is 1-3 cm, the patient is amenable to total urogenital mobilization (TUM) and PSARP. ↗
▶ Ep 103 · 11:49
quote If the urethra is more than 1.5 centimeters, this would be amenable to a total urogenital mobilization and a PSARP. ↗
▶ Ep 103 · 11:49
clinical If urethral length is >1.5 cm and common channel is 1-3 cm, the patient is amenable to total urogenital mobilization (TUM) and PSARP. ↗
▶ Ep 103 · 12:07
clinical If urethral length is <1.5 cm, urogenital separation (UGS) is advocated, because performing TUM on a 1 cm urethra would place the bladder neck near the perineum and could render the patient incontinent. ↗
▶ Ep 103 · 12:07
quote If the urethra is less than 1.5 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 1 centimeter urethra, and although these patients aren't common, they do exist, then you will have the bladder neck sewn right near the perineum, and that could render the patient incontinent. ↗
▶ Ep 103 · 12:07
quote If the urethra is less than 1.5 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 1 centimeter urethra, and although these patients aren't common, they do exist, then you will have the bladder neck sewn right near the perineum, and that could render the patient incontinent. ↗
▶ Ep 103 · 12:07
clinical If urethral length is <1.5 cm, urogenital separation (UGS) is advocated, because performing TUM on a 1 cm urethra would place the bladder neck near the perineum and could render the patient incontinent. ↗
▶ Ep 103 · 12:29
clinical The majority of 1-3 cm common channel cloacas have a normal length urethra and are amenable to TUM. ↗
▶ Ep 103 · 12:29
clinical The majority of 1-3 cm common channel cloacas have a normal length urethra and are amenable to TUM. ↗
▶ Ep 103 · 12:44
clinical For common channel >3 cm, patients often have urethral length <1.5 cm; in either case, UGS is advocated with repair of the common channel (left as the urethra), mobilization of the vagina to the perineum, and PSARP. ↗
▶ Ep 103 · 12:44
clinical For common channel >3 cm, patients often have urethral length <1.5 cm; in either case, UGS is advocated with repair of the common channel (left as the urethra), mobilization of the vagina to the perineum, and PSARP. ↗
▶ Ep 103 · 12:55
quote If either of those things are the case [common channel >3 cm or urethra <1.5 cm], then we would advocate for a urogenital separation and a repair of the common channel which we leave as the urethra, and mobilization of the vagina down to the perineum and a PSARP. ↗
▶ Ep 103 · 12:55
quote If either of those things are the case [common channel >3 cm or urethra <1.5 cm], then we would advocate for a urogenital separation and a repair of the common channel which we leave as the urethra, and mobilization of the vagina down to the perineum and a PSARP. ↗
▶ Ep 103 · 13:18
clinical If the vagina or vaginas cannot reach the perineum, the patient may need vaginal replacement to bridge the gap. ↗
▶ Ep 103 · 13:18
quote If the vagina or vaginas are unable to reach the perineum, then the patient may need a vaginal replacement in order to bridge the gap. ↗
▶ Ep 103 · 13:18
quote If the vagina or vaginas are unable to reach the perineum, then the patient may need a vaginal replacement in order to bridge the gap. ↗
▶ Ep 103 · 13:18
clinical If the vagina or vaginas cannot reach the perineum, the patient may need vaginal replacement to bridge the gap. ↗
▶ Ep 103 · 13:34
clinical If the rectum is high, consider an abdominal approach (open or laparoscopic-assisted PSARP) to mobilize rectal length. ↗
▶ Ep 103 · 13:34
quote If the rectum is high, you may want to consider doing that with an abdominal approach to mobilize first. And so that may change your PSARP approach to a laparoscopic assisted PSARP in order to mobilize length. ↗
▶ Ep 103 · 13:34
quote If the rectum is high, you may want to consider doing that with an abdominal approach to mobilize first. And so that may change your PSARP approach to a laparoscopic assisted PSARP in order to mobilize length. ↗
▶ Ep 103 · 13:34
clinical If the rectum is high, consider an abdominal approach (open or laparoscopic-assisted PSARP) to mobilize rectal length. ↗
▶ Ep 103 · 17:34
quote I will say that I was just relieved that Doctor Hendren didn't have a question for me, if I can be completely honest. ↗
▶ Ep 103 · 17:34
quote I will say that I was just relieved that Doctor Hendren didn't have a question for me, if I can be completely honest. ↗
▶ Ep 103 · 17:40
quote If you just stick to the algorithm, it really works. And we've looked at this, and I think it's now 116 patients in a row. And if you follow the algorithm, we haven't once had to change the plan. ↗
▶ Ep 103 · 17:40
quote If you just stick to the algorithm, it really works. And we've looked at this, and I think it's now 116 patients in a row. And if you follow the algorithm, we haven't once had to change the plan. ↗
▶ Ep 103 · 17:52
clinical The algorithm has been validated in 116 consecutive patients without a single intraoperative plan change. ↗
▶ Ep 103 · 17:52
clinical The algorithm has been validated in 116 consecutive patients without a single intraoperative plan change. ↗
▶ Ep 103 · 18:01
opinion Following the algorithm using the 3 cm and 1.5 cm thresholds allows surgeons to stay out of trouble; it provides a guide for which cases are reproducible and which require referral. ↗
▶ Ep 103 · 18:01
opinion Following the algorithm using the 3 cm and 1.5 cm thresholds allows surgeons to stay out of trouble; it provides a guide for which cases are reproducible and which require referral. ↗
▶ Ep 103 · 18:11
quote If you're not an experienced cloacal surgeon, it gives you a really good guide as to which ones are reproducible and which ones you might want to get help from a friend with. ↗
▶ Ep 103 · 18:11
quote If you're not an experienced cloacal surgeon, it gives you a really good guide as to which ones are reproducible and which ones you might want to get help from a friend with. ↗
▶ Ep 103 · 19:09
quote What we mean is that it's when your common channel splits, it's the distance from where the urethra leaves the common channel to where it enters the bladder. ↗
▶ Ep 103 · 19:09
clinical Urethral length is defined as the distance from where the common channel splits (urethra separates from vagina) to where the urethra enters the bladder, not from the single perineal orifice to the bladder neck. ↗
▶ Ep 103 · 19:09
quote What we mean is that it's when your common channel splits, it's the distance from where the urethra leaves the common channel to where it enters the bladder. ↗
▶ Ep 103 · 19:09
clinical Urethral length is defined as the distance from where the common channel splits (urethra separates from vagina) to where the urethra enters the bladder, not from the single perineal orifice to the bladder neck. ↗
▶ Ep 103 · 19:20
clinical Measuring urethral length accurately with a cystoscope is difficult because the scope must navigate the curve behind the pubis, leading to significant under- or over-reading; this is especially important in longer common channel cases. ↗
▶ Ep 103 · 19:20
quote That's what's difficult to measure really accurately with a cystoscope because you're around that curve that we can see in the picture. And so because you're around that curve behind the pubis in these longer ones where it's actually really important, you can seriously under and overread that and that's what that study that we did showed. ↗
▶ Ep 103 · 19:20
clinical Measuring urethral length accurately with a cystoscope is difficult because the scope must navigate the curve behind the pubis, leading to significant under- or over-reading; this is especially important in longer common channel cases. ↗
▶ Ep 103 · 19:20
quote That's what's difficult to measure really accurately with a cystoscope because you're around that curve that we can see in the picture. And so because you're around that curve behind the pubis in these longer ones where it's actually really important, you can seriously under and overread that and that's what that study that we did showed. ↗
▶ Ep 103 · 19:40
quote Getting an accurate measurement of the urethra is fundamentally important because what we want to do is land up with a bladder neck above the urogenital diaphragm, which is where the external sphincter or where the sphincter complex, the urethra lies. And also just then your intraabdominal pressure doesn't mess you up. ↗
▶ Ep 103 · 19:40
quote Getting an accurate measurement of the urethra is fundamentally important because what we want to do is land up with a bladder neck above the urogenital diaphragm, which is where the external sphincter or where the sphincter complex, the urethra lies. And also just then your intraabdominal pressure doesn't mess you up. ↗
▶ Ep 103 · 19:40
clinical The goal is to position the bladder neck above the urogenital diaphragm, where the external sphincter complex and urethra lie, so that intraabdominal pressure does not compromise continence. ↗
▶ Ep 103 · 19:40
clinical The goal is to position the bladder neck above the urogenital diaphragm, where the external sphincter complex and urethra lie, so that intraabdominal pressure does not compromise continence. ↗
▶ Ep 103 · 19:59
clinical Urethral length can be measured using a ureteric catheter under fluoroscopy or with a scope, but the most accurate measurement comes from 3D imaging because it does not straighten structures and falsely measure them. ↗
▶ Ep 103 · 19:59
quote You can use a ureteric catheter, which you can watch and measure it that way, or you can measure it on your scope, but your most accurate measurement probably comes from your imaging because it's not straightening all the structures out and then falsely measuring them. ↗
▶ Ep 103 · 19:59
clinical Urethral length can be measured using a ureteric catheter under fluoroscopy or with a scope, but the most accurate measurement comes from 3D imaging because it does not straighten structures and falsely measure them. ↗
▶ Ep 103 · 19:59
quote You can use a ureteric catheter, which you can watch and measure it that way, or you can measure it on your scope, but your most accurate measurement probably comes from your imaging because it's not straightening all the structures out and then falsely measuring them. ↗

Journal of Pediatric Surgery Article Review: October 2021

▶ Ep 110 · 10:37
clinical The Nationwide Children's Hospital bowel management program started recording outcomes in a standardized way in 2015 using standardized definitions and patient-reported outcome and experience measures. ↗
▶ Ep 110 · 11:32
clinical The bowel management study measured outcomes at one year rather than one week because one-week outcomes represent an artificial environment, and one-year measurement demonstrates sustained changes within the patient's normal environment. ↗
▶ Ep 110 · 11:59
quote But what we were able to show in the study was that if you look at the kids who were clean, their quality of life significantly improved. And if you look at the kids that are not clean, their quality of life did not improve at all. ↗
▶ Ep 110 · 11:59
clinical In the bowel management program, children who achieved continence had significantly improved quality of life, while those who remained incontinent had no quality of life improvement. ↗
▶ Ep 110 · 12:29
quote It's very sobering to realize that although you throw all these resources at these patients, you have a cohort of 30% that you have not improved their quality of life and that they're still having accidents. ↗
▶ Ep 110 · 12:56
clinical In the bowel management study, 70% of children achieve good outcomes, allowing focus on understanding and improving outcomes for the remaining 30%. ↗

Colorectal Quiz Episode 24: Cloaca Part 3

▶ Ep 117 · 3:47
epidemiological About 30 to 50% of children with cloacal malformations will develop long-term renal dysfunction. ↗
▶ Ep 117 · 10:28
clinical Lateral attachments posteriorly on the vagina, where the blood supply lies, represent an important safe plane for TUM mobilization. ↗
▶ Ep 117 · 10:52
clinical Full mobilization into the peritoneum is necessary to adequately release the rectum and visualize vaginal attachments during TUM. ↗
▶ Ep 117 · 10:52
quote You have to really go into the peritoneum with these releases because you've got to get the rectum out of the way to be able to mobilize the posterior vagina. ↗
▶ Ep 117 · 13:00
clinical For TUM, the common channel is opened widely until the urethral and vaginal openings are clearly visible, often requiring opening into the vagina. ↗
▶ Ep 117 · 13:49
clinical Remeasuring the common channel intraoperatively after opening it is important to confirm preoperative measurements and ensure TUM is still appropriate. ↗
▶ Ep 117 · 17:18
clinical For TUM, full-thickness lateral dissection is essential; inadequate dissection causes the common channel to fall apart and leaves poor tissue for suturing. ↗
▶ Ep 117 · 17:43
clinical The common channel should be divided approximately 0.5 centimeters behind the clitoral tissue to avoid damaging nerve supply. ↗
▶ Ep 117 · 18:19
quote I think it's important also to keep feeling where the pubis is. So you make sure you get to the bottom of the pubis where the suspensory ligaments start. ↗
▶ Ep 117 · 18:49
quote I don't think you always have to go to the space of Rhetsius in order to get an adequate TUM without tension. I think sometimes you can do the lower suspensory ligaments and you're reaching tension-free, and I think it's fine at that point to just do a partial TUM. ↗
▶ Ep 117 · 23:43
clinical When the vagina is the most posterior structure in a cloacal malformation, it is often stuck to the presacral fascia and more difficult to mobilize than the rectum. ↗
▶ Ep 117 · 28:49
clinical In higher common channel cases, the ureters often come quite close to the bladder neck, requiring careful mapping during surgery. ↗
▶ Ep 117 · 29:11
clinical Once dissection reaches within 0.5 centimeters of where the ureters are, no more separation should be done safely from the posterior sagittal approach. ↗
▶ Ep 117 · 29:45
clinical Placing ureteric stents via cystoscopy prior to laparoscopic separation provides reassurance about ureter location during dissection. ↗
▶ Ep 117 · 30:55
clinical During laparoscopic separation, scissors with minimal or no cautery are used for the actual separation to avoid thermal injury to the urethra. ↗
▶ Ep 117 · 31:20
clinical Laparoscopic dissection appears to result in fewer vaginal replacements, possibly due to better visualization deep in the pelvis. ↗
▶ Ep 117 · 31:39
clinical Vaginal length is the most significant predictor of need for vaginal replacement; vaginas less than 4 cm are much more likely to need replacement, while those over 6 cm are much less likely. ↗
▶ Ep 117 · 32:39
quote Once you're through in the midline, you can very carefully work laterally and make sure you can see the ureters so we don't injure them. ↗
▶ Ep 117 · 32:53
clinical After implementing double-layer urethral repair with SIS and fat pad interposition, no urethrovaginal fistulas have occurred in 5.5 years. ↗
▶ Ep 117 · 34:16
quote The vagina tends to sort of envelop the bladder neck a little bit. And so it often sort of wraps around it. And you have to be pretty careful when you're doing the separation that you keep working around it and making sure you're not getting into the bladder neck. ↗
▶ Ep 117 · 34:16
clinical The vagina tends to envelop the bladder neck during separation, unlike the rectum in male repairs which stays in its lane, requiring careful circumferential dissection. ↗
▶ Ep 117 · 37:24
clinical Using the protocol with preserved common channel, 97% of patients maintain a catheterizable urethra. ↗
▶ Ep 117 · 37:24
quote If you use this protocol and you repair the urethra without opening the common channel, We were able to have 97% of patients have a catheterizable urethra. ↗
▶ Ep 117 · 37:40
opinion Maintaining perineal access to the bladder is valuable even if a Mitrofanoff is eventually needed, as it provides a pop-off that allows patients to empty. ↗

Colorectal Quiz Episode 18: Cloaca Part 2

▶ Ep 237 · 1:56
clinical The workup includes multidisciplinary team evaluation (urology, gynecology, colorectal) followed by cystovaginoscopy and examination under anesthesia ↗
▶ Ep 237 · 1:56
clinical The workup includes multidisciplinary team evaluation (urology, gynecology, colorectal) followed by cystovaginoscopy and examination under anesthesia ↗
▶ Ep 237 · 2:31
clinical Preoperative urodynamics catheter is placed in the bladder as part of the examination ↗
▶ Ep 237 · 2:31
clinical Preoperative urodynamics catheter is placed in the bladder as part of the examination ↗
▶ Ep 237 · 3:08
clinical During cystoscopy of the common channel, the easiest structure to enter is usually the vagina or vaginas; entering the urethra and bladder is challenging because it requires pointing very far up ↗
▶ Ep 237 · 3:08
quote What's the first structure that you encounter when doing a common channel scope? And as Mark said, the easiest structure to get into when you do a cystoscopy of the common channel is you usually go straight into the vagina or vaginas. ↗
▶ Ep 237 · 3:08
clinical During cystoscopy of the common channel, the easiest structure to enter is usually the vagina or vaginas; entering the urethra and bladder is challenging because it requires pointing very far up ↗
▶ Ep 237 · 3:08
quote What's the first structure that you encounter when doing a common channel scope? And as Mark said, the easiest structure to get into when you do a cystoscopy of the common channel is you usually go straight into the vagina or vaginas. ↗
▶ Ep 237 · 3:30
quote It's actually quite challenging to get into the urethra and the bladder because you have to really point very far up to take that turn. ↗
▶ Ep 237 · 3:30
quote It's actually quite challenging to get into the urethra and the bladder because you have to really point very far up to take that turn. ↗
▶ Ep 237 · 3:30
clinical During endoscopy, surgeons measure the length of the urethra, common channel, and vagina, and assess for the presence of a septum and location of the rectal fistula ↗
▶ Ep 237 · 3:30
clinical During endoscopy, surgeons measure the length of the urethra, common channel, and vagina, and assess for the presence of a septum and location of the rectal fistula ↗
▶ Ep 237 · 4:00
clinical 3D cloacogram is acquired by injecting contrast into all three structures (urethra, vagina, rectum) and using vascular C-arm software to reconstruct three-dimensional images ↗
▶ Ep 237 · 4:00
clinical 3D cloacogram is acquired by injecting contrast into all three structures (urethra, vagina, rectum) and using vascular C-arm software to reconstruct three-dimensional images ↗
▶ Ep 237 · 10:07
clinical For common channel less than 1 cm (type one cloaca), the malformation is essentially a hypospadiac urethra with a rectovaginal fistula ↗
▶ Ep 237 · 10:07
clinical For common channel less than 1 cm (type one cloaca), the malformation is essentially a hypospadiac urethra with a rectovaginal fistula ↗
▶ Ep 237 · 10:20
quote If the common channel is less than a centimeter long, we would generally call that a type one cloaca. It's really a hypospatic urethra with a rectovaginal fistula. ↗
▶ Ep 237 · 10:20
quote If the common channel is less than a centimeter long, we would generally call that a type one cloaca. It's really a hypospatic urethra with a rectovaginal fistula. ↗
▶ Ep 237 · 10:40
clinical In type one cloaca (common channel <1 cm), the hypospadiac urethral orifice is not touched, and the plan is vaginoplasty, introitoplasty, and PSARP ↗
▶ Ep 237 · 10:40
clinical In type one cloaca (common channel <1 cm), the hypospadiac urethral orifice is not touched, and the plan is vaginoplasty, introitoplasty, and PSARP ↗
▶ Ep 237 · 11:10
clinical Even in type one cloaca with short common channel, the true rectum can still be high, so knowing rectal height is important ↗
▶ Ep 237 · 11:10
clinical Even in type one cloaca with short common channel, the true rectum can still be high, so knowing rectal height is important ↗
▶ Ep 237 · 11:30
quote So a normal urethra, we want to be at least one and a half centimeters. ↗
▶ Ep 237 · 11:30
quote So a normal urethra, we want to be at least one and a half centimeters. ↗
▶ Ep 237 · 11:30
clinical A normal urethra should be at least 1.5 cm in length ↗
▶ Ep 237 · 11:30
clinical A normal urethra should be at least 1.5 cm in length ↗
▶ Ep 237 · 11:40
clinical For common channel 1-3 cm with urethral length >1.5 cm, the patient is amenable to total urogenital mobilization (TUM) and PSARP ↗
▶ Ep 237 · 11:40
clinical For common channel 1-3 cm with urethral length >1.5 cm, the patient is amenable to total urogenital mobilization (TUM) and PSARP ↗
▶ Ep 237 · 12:46
clinical For common channel >3 cm, patients often have urethral length <1.5 cm, and urogenital separation with repair of the common channel as the urethra is advocated ↗
▶ Ep 237 · 12:46
clinical For common channel >3 cm, patients often have urethral length <1.5 cm, and urogenital separation with repair of the common channel as the urethra is advocated ↗
▶ Ep 237 · 13:32
clinical If the rectum is high, surgeons may want to consider an abdominal approach to mobilize first, changing the PSARP approach to LARP (laparoscopic-assisted PSARP) ↗
▶ Ep 237 · 13:32
clinical If the rectum is high, surgeons may want to consider an abdominal approach to mobilize first, changing the PSARP approach to LARP (laparoscopic-assisted PSARP) ↗
▶ Ep 237 · 17:36
clinical Following the algorithm, 116 consecutive patients have been managed without needing to change the surgical plan ↗
▶ Ep 237 · 17:36
clinical Following the algorithm, 116 consecutive patients have been managed without needing to change the surgical plan ↗
▶ Ep 237 · 17:50
quote I think it's now 116 patients in a row. And if you follow the algorithm, we haven't once had to change the plan. ↗
▶ Ep 237 · 17:50
quote I think it's now 116 patients in a row. And if you follow the algorithm, we haven't once had to change the plan. ↗
▶ Ep 237 · 19:09
clinical Urethral length is defined as the distance from where the common channel splits (where urethra leaves the common channel) to where it enters the bladder, not from the single orifice to the bladder neck ↗
▶ Ep 237 · 19:09
clinical Urethral length is defined as the distance from where the common channel splits (where urethra leaves the common channel) to where it enters the bladder, not from the single orifice to the bladder neck ↗
▶ Ep 237 · 19:09
quote What we mean is that it's when your common channel splits, it's the distance from where the urethra leaves the common channel to where it enters the bladder and so that's what's difficult to measure really accurately with a cystoscope because you're around that curve that we can see in the picture. ↗
▶ Ep 237 · 19:09
quote What we mean is that it's when your common channel splits, it's the distance from where the urethra leaves the common channel to where it enters the bladder and so that's what's difficult to measure really accurately with a cystoscope because you're around that curve that we can see in the picture. ↗
▶ Ep 237 · 19:40
clinical Measuring urethral length accurately with cystoscopy is difficult because of the curve behind the pubis, which can lead to significant under- and over-reading ↗
▶ Ep 237 · 19:40
clinical Measuring urethral length accurately with cystoscopy is difficult because of the curve behind the pubis, which can lead to significant under- and over-reading ↗
▶ Ep 237 · 20:00
quote What we want to do is land up with a bladder neck above the urogenital diaphragm which is where the external sphincter or where the sphincter complex of the urethra lies and also just then your intra-abdominal pressure doesn't mess you up. ↗
▶ Ep 237 · 20:00
quote What we want to do is land up with a bladder neck above the urogenital diaphragm which is where the external sphincter or where the sphincter complex of the urethra lies and also just then your intra-abdominal pressure doesn't mess you up. ↗
▶ Ep 237 · 20:10
clinical The goal is to position the bladder neck above the urogenital diaphragm where the external sphincter complex lies, so that intra-abdominal pressure does not compromise continence ↗
▶ Ep 237 · 20:10
clinical The goal is to position the bladder neck above the urogenital diaphragm where the external sphincter complex lies, so that intra-abdominal pressure does not compromise continence ↗
▶ Ep 237 · 20:20
clinical The most accurate urethral measurement comes from 3D imaging rather than cystoscopy because imaging does not straighten the structures and falsely measure them ↗
▶ Ep 237 · 20:20
clinical The most accurate urethral measurement comes from 3D imaging rather than cystoscopy because imaging does not straighten the structures and falsely measure them ↗

Colorectal Quiz Episode 17: Cloaca Part 1

▶ Ep 238 · 2:05
quote The single perineal orifice should clue you into a cloaca. The vagina, urethra, and rectum are fused together inside, creating a single common channel. ↗
▶ Ep 238 · 2:05
clinical A single perineal orifice in a newborn indicates cloaca, where the vagina, urethra, and rectum are fused together inside creating a single common channel. ↗
▶ Ep 238 · 2:05
quote The single perineal orifice should clue you into a cloaca. The vagina, urethra, and rectum are fused together inside, creating a single common channel. ↗
▶ Ep 238 · 2:05
clinical A single perineal orifice in a newborn indicates cloaca, where the vagina, urethra, and rectum are fused together inside creating a single common channel. ↗
▶ Ep 238 · 2:25
clinical Hydrocolpos is the distension of the vagina caused by accumulation of fluid. ↗
▶ Ep 238 · 2:25
clinical Hydrocolpos is the distension of the vagina caused by accumulation of fluid. ↗
▶ Ep 238 · 2:45
quote The key point here is that a cloaca or an anal rectal malformation is associated with bacterial and needs to be worked up as such. ↗
▶ Ep 238 · 2:45
guideline Cloaca or anorectal malformation is associated with VACTERL and needs to be worked up as such. ↗
▶ Ep 238 · 2:45
guideline Cloaca or anorectal malformation is associated with VACTERL and needs to be worked up as such. ↗
▶ Ep 238 · 2:45
quote The key point here is that a cloaca or an anal rectal malformation is associated with bacterial and needs to be worked up as such. ↗
▶ Ep 238 · 3:44
epidemiological The diagnostic yield for cloaca on prenatal ultrasound is still much lower than desired. ↗
▶ Ep 238 · 3:44
epidemiological The diagnostic yield for cloaca on prenatal ultrasound is still much lower than desired. ↗
▶ Ep 238 · 4:00
quote A hydrocorpus on a prenatal ultrasound should alert us to a possibility of a cloaca. ↗
▶ Ep 238 · 4:00
clinical Hydrocolpos on prenatal ultrasound should alert to the possibility of cloaca. ↗
▶ Ep 238 · 4:00
clinical Hydrocolpos on prenatal ultrasound should alert to the possibility of cloaca. ↗
▶ Ep 238 · 4:00
quote A hydrocorpus on a prenatal ultrasound should alert us to a possibility of a cloaca. ↗
▶ Ep 238 · 4:12
clinical Prenatal findings suggestive of cloaca include abnormal kidneys, single kidney, and two-vessel cord association. ↗
▶ Ep 238 · 4:12
clinical Prenatal findings suggestive of cloaca include abnormal kidneys, single kidney, and two-vessel cord association. ↗
▶ Ep 238 · 6:19
clinical Good physical exam with good lighting is the first step in evaluating suspected cloaca. ↗
▶ Ep 238 · 6:19
clinical Good physical exam with good lighting is the first step in evaluating suspected cloaca. ↗
▶ Ep 238 · 6:28
clinical On exam, distracting the labia reveals more of a clitoral hood than real labia minora, with a single perineal orifice posterior to the clitoral hood. ↗
▶ Ep 238 · 6:28
clinical On exam, distracting the labia reveals more of a clitoral hood than real labia minora, with a single perineal orifice posterior to the clitoral hood. ↗
▶ Ep 238 · 6:40
clinical A perineal groove behind the labia structures and dimpling representing muscle complex suggests the perineum is not completely flat. ↗
▶ Ep 238 · 6:40
clinical A perineal groove behind the labia structures and dimpling representing muscle complex suggests the perineum is not completely flat. ↗
▶ Ep 238 · 7:20
quote In a child with a cloacal malformation who does not have an anus, there really isn't an indication to investigate for ambiguae stenitalia or disorders of sexual differentiation. Because we know that these children with cloacas are female and they don't need that workup. ↗
▶ Ep 238 · 7:20
guideline Children with cloacal malformation who do not have an anus do not need investigation for ambiguous genitalia or disorders of sexual differentiation because they are known to be female. ↗
▶ Ep 238 · 7:20
guideline Children with cloacal malformation who do not have an anus do not need investigation for ambiguous genitalia or disorders of sexual differentiation because they are known to be female. ↗
▶ Ep 238 · 7:20
quote In a child with a cloacal malformation who does not have an anus, there really isn't an indication to investigate for ambiguae stenitalia or disorders of sexual differentiation. Because we know that these children with cloacas are female and they don't need that workup. ↗
▶ Ep 238 · 7:56
guideline Initial urgent management priorities are ensuring kidney decompression/urine drainage, diagnosing hydrocolpos, and confirming safety for OR (ruling out TEF and cardiac issues). ↗
▶ Ep 238 · 7:56
guideline Initial urgent management priorities are ensuring kidney decompression/urine drainage, diagnosing hydrocolpos, and confirming safety for OR (ruling out TEF and cardiac issues). ↗
▶ Ep 238 · 8:30
guideline Initial workup should consist of NG tube and chest x-ray, cardiac echo, and pelvic and renal ultrasound to assess for TEF, cardiac anomalies, hydrocolpos, and hydronephrosis. ↗
▶ Ep 238 · 8:30
guideline Initial workup should consist of NG tube and chest x-ray, cardiac echo, and pelvic and renal ultrasound to assess for TEF, cardiac anomalies, hydrocolpos, and hydronephrosis. ↗
▶ Ep 238 · 8:50
clinical Bilateral hydronephrosis with hydrocolpos requires management of the hydrocolpos as part of initial treatment. ↗
▶ Ep 238 · 8:50
clinical Bilateral hydronephrosis with hydrocolpos requires management of the hydrocolpos as part of initial treatment. ↗
▶ Ep 238 · 9:11
guideline The modern approach has moved heavily away from vaginostomy toward clean intermittent catheterization through the common channel for hydrocolpos drainage. ↗
▶ Ep 238 · 9:11
quote We've moved heavily away from doing vaginostomies and much more with doing CIC through the common channel. ↗
▶ Ep 238 · 9:11
guideline The modern approach has moved heavily away from vaginostomy toward clean intermittent catheterization through the common channel for hydrocolpos drainage. ↗
▶ Ep 238 · 9:11
quote We've moved heavily away from doing vaginostomies and much more with doing CIC through the common channel. ↗
▶ Ep 238 · 9:24
clinical To perform CIC for hydrocolpos, pass a tube through the common channel, drain fluid, get ultrasound to confirm the tube is in the hydrocolpos/vagina, confirm decompression, then continue recurrently. ↗
▶ Ep 238 · 9:24
clinical To perform CIC for hydrocolpos, pass a tube through the common channel, drain fluid, get ultrasound to confirm the tube is in the hydrocolpos/vagina, confirm decompression, then continue recurrently. ↗
▶ Ep 238 · 9:55
guideline If CIC effectively drains the hydrocolpos, proceed with colostomy only and continue drainage postoperatively; if unsuccessful, can return to formal vaginostomy. ↗
▶ Ep 238 · 9:55
guideline If CIC effectively drains the hydrocolpos, proceed with colostomy only and continue drainage postoperatively; if unsuccessful, can return to formal vaginostomy. ↗
▶ Ep 238 · 12:33
guideline To confirm proper catheter placement, pass the tube, leave it in, get bedside ultrasound within first 24 hours to confirm it's in the hydrocolpos and decompressing it. ↗
▶ Ep 238 · 12:33
guideline To confirm proper catheter placement, pass the tube, leave it in, get bedside ultrasound within first 24 hours to confirm it's in the hydrocolpos and decompressing it. ↗
▶ Ep 238 · 15:01
quote If you've got a hydrocopos with completely normal kidneys, it doesn't matter. The important thing is that you're decompressing their kidneys. ↗
▶ Ep 238 · 15:01
guideline Catheterization frequency is typically three times daily initially, then twice daily when family takes over, with serial ultrasounds every 2-3 days initially, then weekly, then monthly after discharge. ↗
▶ Ep 238 · 15:01
clinical The most important measure of successful hydrocolpos drainage is kidney decompression, not the hydrocolpos itself; if kidneys are completely normal, the hydrocolpos doesn't matter. ↗
▶ Ep 238 · 15:01
quote If you've got a hydrocopos with completely normal kidneys, it doesn't matter. The important thing is that you're decompressing their kidneys. ↗
▶ Ep 238 · 15:01
clinical The most important measure of successful hydrocolpos drainage is kidney decompression, not the hydrocolpos itself; if kidneys are completely normal, the hydrocolpos doesn't matter. ↗
▶ Ep 238 · 15:01
guideline Catheterization frequency is typically three times daily initially, then twice daily when family takes over, with serial ultrasounds every 2-3 days initially, then weekly, then monthly after discharge. ↗
▶ Ep 238 · 16:20
guideline Even with vaginostomy tubes, you must continue checking that kidneys remain decompressed; don't assume the tube is doing its job without verification. ↗
▶ Ep 238 · 16:20
guideline Even with vaginostomy tubes, you must continue checking that kidneys remain decompressed; don't assume the tube is doing its job without verification. ↗
▶ Ep 238 · 16:40
quote The message to everyone is, however you drain the hydroculpus, your job is to continue checking the kidneys are decompressed. ↗
▶ Ep 238 · 16:40
quote The message to everyone is, however you drain the hydroculpus, your job is to continue checking the kidneys are decompressed. ↗
▶ Ep 238 · 17:02
guideline Newborn management bullet points: good exam with good light to diagnose, no endocrine workup for cloaca, renal/pelvic ultrasound plus tests for anesthesia safety, drain hydrocolpos by CIC, and colostomy within 24-48 hours. ↗
▶ Ep 238 · 17:02
guideline Newborn management bullet points: good exam with good light to diagnose, no endocrine workup for cloaca, renal/pelvic ultrasound plus tests for anesthesia safety, drain hydrocolpos by CIC, and colostomy within 24-48 hours. ↗
▶ Ep 238 · 17:53
guideline Colostomy should be done as proximally as possible (descending-sigmoid junction) to ensure enough length for distal work, rather than lower sigmoid. ↗
▶ Ep 238 · 17:53
quote I would advocate for doing your colostomy as proximally as you can in this situation to make sure that you have enough length for distal work. So I'd probably do it at the descending sigmoid junction rather than sort of any lower down sigmoid. ↗
▶ Ep 238 · 17:53
guideline Colostomy should be done as proximally as possible (descending-sigmoid junction) to ensure enough length for distal work, rather than lower sigmoid. ↗
▶ Ep 238 · 17:53
quote I would advocate for doing your colostomy as proximally as you can in this situation to make sure that you have enough length for distal work. So I'd probably do it at the descending sigmoid junction rather than sort of any lower down sigmoid. ↗
▶ Ep 238 · 18:42
clinical Laparoscopy for newborn colostomy in non-distended patients provides good pelvic anatomy visualization, allows precise colostomy site selection, and avoids wound between stomas. ↗
▶ Ep 238 · 18:42
clinical Laparoscopy for newborn colostomy in non-distended patients provides good pelvic anatomy visualization, allows precise colostomy site selection, and avoids wound between stomas. ↗
▶ Ep 238 · 19:25
clinical Laparoscopic technique: mobilize lateral attachments of descending colon, bring bowel up through mucous fistula site, staple it, wash out distal limb completely, then make separate incision for proximal stoma with no surrounding incision for clean skin and easy bagging. ↗
▶ Ep 238 · 19:25
clinical Laparoscopic technique: mobilize lateral attachments of descending colon, bring bowel up through mucous fistula site, staple it, wash out distal limb completely, then make separate incision for proximal stoma with no surrounding incision for clean skin and easy bagging. ↗
▶ Ep 238 · 20:15
clinical For vaginostomy in patients with vaginal septum, open the anterior wall of the hydrocolpos vagina and remove a small portion of septum to drain both sides through one hole. ↗
▶ Ep 238 · 20:15
clinical For vaginostomy in patients with vaginal septum, open the anterior wall of the hydrocolpos vagina and remove a small portion of septum to drain both sides through one hole. ↗
▶ Ep 238 · 20:45
opinion Vaginostomy can be done with or without tubes; tubes can become encrusted and colonized, so tubeless has some advantage if anatomy allows easy reach to abdominal wall. ↗
▶ Ep 238 · 20:45
opinion Vaginostomy can be done with or without tubes; tubes can become encrusted and colonized, so tubeless has some advantage if anatomy allows easy reach to abdominal wall. ↗
▶ Ep 238 · 24:36
guideline Post-discharge follow-up focuses on ensuring kidneys are well decompressed, patient is growing well, following kidney function tests, and ensuring parents manage stoma effectively. ↗
▶ Ep 238 · 24:36
guideline Post-discharge follow-up focuses on ensuring kidneys are well decompressed, patient is growing well, following kidney function tests, and ensuring parents manage stoma effectively. ↗
▶ Ep 238 · 25:20
clinical With effective urine and stool drainage, patients should be thriving unless other underlying issues exist. ↗
▶ Ep 238 · 25:20
clinical With effective urine and stool drainage, patients should be thriving unless other underlying issues exist. ↗
Etiologies (Gastroschisis/NEC/Atresia/Volvulus) 6 entries

Journal of Pediatric Surgery Article Review: October 2021

▶ Ep 33 · 10:37
clinical The Nationwide Children's Hospital bowel management program started recording outcomes in a standardized way in 2015 using standardized definitions and patient-reported outcome and experience measures. ↗
▶ Ep 33 · 11:32
clinical The bowel management study measured outcomes at one year rather than one week because one-week outcomes represent an artificial environment, and one-year measurement demonstrates sustained changes within the patient's normal environment. ↗
▶ Ep 33 · 11:59
clinical In the bowel management program, children who achieved continence had significantly improved quality of life, while those who remained incontinent had no quality of life improvement. ↗
▶ Ep 33 · 11:59
quote But what we were able to show in the study was that if you look at the kids who were clean, their quality of life significantly improved. And if you look at the kids that are not clean, their quality of life did not improve at all. ↗
▶ Ep 33 · 12:29
quote It's very sobering to realize that although you throw all these resources at these patients, you have a cohort of 30% that you have not improved their quality of life and that they're still having accidents. ↗
▶ Ep 33 · 12:56
clinical In the bowel management study, 70% of children achieve good outcomes, allowing focus on understanding and improving outcomes for the remaining 30%. ↗
Hydrocolpos 72 entries

Colorectal Quiz Episode 17: Cloaca Part 1

▶ Ep 4 · 2:05
quote The single perineal orifice should clue you into a cloaca. The vagina, urethra, and rectum are fused together inside, creating a single common channel. ↗
▶ Ep 4 · 2:05
quote The single perineal orifice should clue you into a cloaca. The vagina, urethra, and rectum are fused together inside, creating a single common channel. ↗
▶ Ep 4 · 2:05
clinical A single perineal orifice in a newborn indicates cloaca, where the vagina, urethra, and rectum are fused together inside creating a single common channel. ↗
▶ Ep 4 · 2:05
clinical A single perineal orifice in a newborn indicates cloaca, where the vagina, urethra, and rectum are fused together inside creating a single common channel. ↗
▶ Ep 4 · 2:25
clinical Hydrocolpos is the distension of the vagina caused by accumulation of fluid. ↗
▶ Ep 4 · 2:25
clinical Hydrocolpos is the distension of the vagina caused by accumulation of fluid. ↗
▶ Ep 4 · 2:45
guideline Cloaca or anorectal malformation is associated with VACTERL and needs to be worked up as such. ↗
▶ Ep 4 · 2:45
guideline Cloaca or anorectal malformation is associated with VACTERL and needs to be worked up as such. ↗
▶ Ep 4 · 2:45
quote The key point here is that a cloaca or an anal rectal malformation is associated with bacterial and needs to be worked up as such. ↗
▶ Ep 4 · 2:45
quote The key point here is that a cloaca or an anal rectal malformation is associated with bacterial and needs to be worked up as such. ↗
▶ Ep 4 · 3:44
epidemiological The diagnostic yield for cloaca on prenatal ultrasound is still much lower than desired. ↗
▶ Ep 4 · 3:44
epidemiological The diagnostic yield for cloaca on prenatal ultrasound is still much lower than desired. ↗
▶ Ep 4 · 4:00
clinical Hydrocolpos on prenatal ultrasound should alert to the possibility of cloaca. ↗
▶ Ep 4 · 4:00
clinical Hydrocolpos on prenatal ultrasound should alert to the possibility of cloaca. ↗
▶ Ep 4 · 4:00
quote A hydrocorpus on a prenatal ultrasound should alert us to a possibility of a cloaca. ↗
▶ Ep 4 · 4:00
quote A hydrocorpus on a prenatal ultrasound should alert us to a possibility of a cloaca. ↗
▶ Ep 4 · 4:12
clinical Prenatal findings suggestive of cloaca include abnormal kidneys, single kidney, and two-vessel cord association. ↗
▶ Ep 4 · 4:12
clinical Prenatal findings suggestive of cloaca include abnormal kidneys, single kidney, and two-vessel cord association. ↗
▶ Ep 4 · 6:19
clinical Good physical exam with good lighting is the first step in evaluating suspected cloaca. ↗
▶ Ep 4 · 6:19
clinical Good physical exam with good lighting is the first step in evaluating suspected cloaca. ↗
▶ Ep 4 · 6:28
clinical On exam, distracting the labia reveals more of a clitoral hood than real labia minora, with a single perineal orifice posterior to the clitoral hood. ↗
▶ Ep 4 · 6:28
clinical On exam, distracting the labia reveals more of a clitoral hood than real labia minora, with a single perineal orifice posterior to the clitoral hood. ↗
▶ Ep 4 · 6:40
clinical A perineal groove behind the labia structures and dimpling representing muscle complex suggests the perineum is not completely flat. ↗
▶ Ep 4 · 6:40
clinical A perineal groove behind the labia structures and dimpling representing muscle complex suggests the perineum is not completely flat. ↗
▶ Ep 4 · 7:20
quote In a child with a cloacal malformation who does not have an anus, there really isn't an indication to investigate for ambiguae stenitalia or disorders of sexual differentiation. Because we know that these children with cloacas are female and they don't need that workup. ↗
▶ Ep 4 · 7:20
guideline Children with cloacal malformation who do not have an anus do not need investigation for ambiguous genitalia or disorders of sexual differentiation because they are known to be female. ↗
▶ Ep 4 · 7:20
quote In a child with a cloacal malformation who does not have an anus, there really isn't an indication to investigate for ambiguae stenitalia or disorders of sexual differentiation. Because we know that these children with cloacas are female and they don't need that workup. ↗
▶ Ep 4 · 7:20
guideline Children with cloacal malformation who do not have an anus do not need investigation for ambiguous genitalia or disorders of sexual differentiation because they are known to be female. ↗
▶ Ep 4 · 7:56
guideline Initial urgent management priorities are ensuring kidney decompression/urine drainage, diagnosing hydrocolpos, and confirming safety for OR (ruling out TEF and cardiac issues). ↗
▶ Ep 4 · 7:56
guideline Initial urgent management priorities are ensuring kidney decompression/urine drainage, diagnosing hydrocolpos, and confirming safety for OR (ruling out TEF and cardiac issues). ↗
▶ Ep 4 · 8:30
guideline Initial workup should consist of NG tube and chest x-ray, cardiac echo, and pelvic and renal ultrasound to assess for TEF, cardiac anomalies, hydrocolpos, and hydronephrosis. ↗
▶ Ep 4 · 8:30
guideline Initial workup should consist of NG tube and chest x-ray, cardiac echo, and pelvic and renal ultrasound to assess for TEF, cardiac anomalies, hydrocolpos, and hydronephrosis. ↗
▶ Ep 4 · 8:50
clinical Bilateral hydronephrosis with hydrocolpos requires management of the hydrocolpos as part of initial treatment. ↗
▶ Ep 4 · 8:50
clinical Bilateral hydronephrosis with hydrocolpos requires management of the hydrocolpos as part of initial treatment. ↗
▶ Ep 4 · 9:11
guideline The modern approach has moved heavily away from vaginostomy toward clean intermittent catheterization through the common channel for hydrocolpos drainage. ↗
▶ Ep 4 · 9:11
quote We've moved heavily away from doing vaginostomies and much more with doing CIC through the common channel. ↗
▶ Ep 4 · 9:11
guideline The modern approach has moved heavily away from vaginostomy toward clean intermittent catheterization through the common channel for hydrocolpos drainage. ↗
▶ Ep 4 · 9:11
quote We've moved heavily away from doing vaginostomies and much more with doing CIC through the common channel. ↗
▶ Ep 4 · 9:24
clinical To perform CIC for hydrocolpos, pass a tube through the common channel, drain fluid, get ultrasound to confirm the tube is in the hydrocolpos/vagina, confirm decompression, then continue recurrently. ↗
▶ Ep 4 · 9:24
clinical To perform CIC for hydrocolpos, pass a tube through the common channel, drain fluid, get ultrasound to confirm the tube is in the hydrocolpos/vagina, confirm decompression, then continue recurrently. ↗
▶ Ep 4 · 9:55
guideline If CIC effectively drains the hydrocolpos, proceed with colostomy only and continue drainage postoperatively; if unsuccessful, can return to formal vaginostomy. ↗
▶ Ep 4 · 9:55
guideline If CIC effectively drains the hydrocolpos, proceed with colostomy only and continue drainage postoperatively; if unsuccessful, can return to formal vaginostomy. ↗
▶ Ep 4 · 12:33
guideline To confirm proper catheter placement, pass the tube, leave it in, get bedside ultrasound within first 24 hours to confirm it's in the hydrocolpos and decompressing it. ↗
▶ Ep 4 · 12:33
guideline To confirm proper catheter placement, pass the tube, leave it in, get bedside ultrasound within first 24 hours to confirm it's in the hydrocolpos and decompressing it. ↗
▶ Ep 4 · 15:01
clinical The most important measure of successful hydrocolpos drainage is kidney decompression, not the hydrocolpos itself; if kidneys are completely normal, the hydrocolpos doesn't matter. ↗
▶ Ep 4 · 15:01
guideline Catheterization frequency is typically three times daily initially, then twice daily when family takes over, with serial ultrasounds every 2-3 days initially, then weekly, then monthly after discharge. ↗
▶ Ep 4 · 15:01
clinical The most important measure of successful hydrocolpos drainage is kidney decompression, not the hydrocolpos itself; if kidneys are completely normal, the hydrocolpos doesn't matter. ↗
▶ Ep 4 · 15:01
guideline Catheterization frequency is typically three times daily initially, then twice daily when family takes over, with serial ultrasounds every 2-3 days initially, then weekly, then monthly after discharge. ↗
▶ Ep 4 · 15:01
quote If you've got a hydrocopos with completely normal kidneys, it doesn't matter. The important thing is that you're decompressing their kidneys. ↗
▶ Ep 4 · 15:01
quote If you've got a hydrocopos with completely normal kidneys, it doesn't matter. The important thing is that you're decompressing their kidneys. ↗
▶ Ep 4 · 16:20
guideline Even with vaginostomy tubes, you must continue checking that kidneys remain decompressed; don't assume the tube is doing its job without verification. ↗
▶ Ep 4 · 16:20
guideline Even with vaginostomy tubes, you must continue checking that kidneys remain decompressed; don't assume the tube is doing its job without verification. ↗
▶ Ep 4 · 16:40
quote The message to everyone is, however you drain the hydroculpus, your job is to continue checking the kidneys are decompressed. ↗
▶ Ep 4 · 16:40
quote The message to everyone is, however you drain the hydroculpus, your job is to continue checking the kidneys are decompressed. ↗
▶ Ep 4 · 17:02
guideline Newborn management bullet points: good exam with good light to diagnose, no endocrine workup for cloaca, renal/pelvic ultrasound plus tests for anesthesia safety, drain hydrocolpos by CIC, and colostomy within 24-48 hours. ↗
▶ Ep 4 · 17:02
guideline Newborn management bullet points: good exam with good light to diagnose, no endocrine workup for cloaca, renal/pelvic ultrasound plus tests for anesthesia safety, drain hydrocolpos by CIC, and colostomy within 24-48 hours. ↗
▶ Ep 4 · 17:53
quote I would advocate for doing your colostomy as proximally as you can in this situation to make sure that you have enough length for distal work. So I'd probably do it at the descending sigmoid junction rather than sort of any lower down sigmoid. ↗
▶ Ep 4 · 17:53
quote I would advocate for doing your colostomy as proximally as you can in this situation to make sure that you have enough length for distal work. So I'd probably do it at the descending sigmoid junction rather than sort of any lower down sigmoid. ↗
▶ Ep 4 · 17:53
guideline Colostomy should be done as proximally as possible (descending-sigmoid junction) to ensure enough length for distal work, rather than lower sigmoid. ↗
▶ Ep 4 · 17:53
guideline Colostomy should be done as proximally as possible (descending-sigmoid junction) to ensure enough length for distal work, rather than lower sigmoid. ↗
▶ Ep 4 · 18:42
clinical Laparoscopy for newborn colostomy in non-distended patients provides good pelvic anatomy visualization, allows precise colostomy site selection, and avoids wound between stomas. ↗
▶ Ep 4 · 18:42
clinical Laparoscopy for newborn colostomy in non-distended patients provides good pelvic anatomy visualization, allows precise colostomy site selection, and avoids wound between stomas. ↗
▶ Ep 4 · 19:25
clinical Laparoscopic technique: mobilize lateral attachments of descending colon, bring bowel up through mucous fistula site, staple it, wash out distal limb completely, then make separate incision for proximal stoma with no surrounding incision for clean skin and easy bagging. ↗
▶ Ep 4 · 19:25
clinical Laparoscopic technique: mobilize lateral attachments of descending colon, bring bowel up through mucous fistula site, staple it, wash out distal limb completely, then make separate incision for proximal stoma with no surrounding incision for clean skin and easy bagging. ↗
▶ Ep 4 · 20:15
clinical For vaginostomy in patients with vaginal septum, open the anterior wall of the hydrocolpos vagina and remove a small portion of septum to drain both sides through one hole. ↗
▶ Ep 4 · 20:15
clinical For vaginostomy in patients with vaginal septum, open the anterior wall of the hydrocolpos vagina and remove a small portion of septum to drain both sides through one hole. ↗
▶ Ep 4 · 20:45
opinion Vaginostomy can be done with or without tubes; tubes can become encrusted and colonized, so tubeless has some advantage if anatomy allows easy reach to abdominal wall. ↗
▶ Ep 4 · 20:45
opinion Vaginostomy can be done with or without tubes; tubes can become encrusted and colonized, so tubeless has some advantage if anatomy allows easy reach to abdominal wall. ↗
▶ Ep 4 · 24:36
guideline Post-discharge follow-up focuses on ensuring kidneys are well decompressed, patient is growing well, following kidney function tests, and ensuring parents manage stoma effectively. ↗
▶ Ep 4 · 24:36
guideline Post-discharge follow-up focuses on ensuring kidneys are well decompressed, patient is growing well, following kidney function tests, and ensuring parents manage stoma effectively. ↗
▶ Ep 4 · 25:20
clinical With effective urine and stool drainage, patients should be thriving unless other underlying issues exist. ↗
▶ Ep 4 · 25:20
clinical With effective urine and stool drainage, patients should be thriving unless other underlying issues exist. ↗
Intestinal Rehab 6 entries

Journal of Pediatric Surgery Article Review: October 2021

▶ Ep 45 · 10:37
clinical The Nationwide Children's Hospital bowel management program started recording outcomes in a standardized way in 2015 using standardized definitions and patient-reported outcome and experience measures. ↗
▶ Ep 45 · 11:32
clinical The bowel management study measured outcomes at one year rather than one week because one-week outcomes represent an artificial environment, and one-year measurement demonstrates sustained changes within the patient's normal environment. ↗
▶ Ep 45 · 11:59
quote But what we were able to show in the study was that if you look at the kids who were clean, their quality of life significantly improved. And if you look at the kids that are not clean, their quality of life did not improve at all. ↗
▶ Ep 45 · 11:59
clinical In the bowel management program, children who achieved continence had significantly improved quality of life, while those who remained incontinent had no quality of life improvement. ↗
▶ Ep 45 · 12:29
quote It's very sobering to realize that although you throw all these resources at these patients, you have a cohort of 30% that you have not improved their quality of life and that they're still having accidents. ↗
▶ Ep 45 · 12:56
clinical In the bowel management study, 70% of children achieve good outcomes, allowing focus on understanding and improving outcomes for the remaining 30%. ↗
Necrotizing Enterocolitis 6 entries

Journal of Pediatric Surgery Article Review: October 2021

▶ Ep 7 · 10:37
clinical The Nationwide Children's Hospital bowel management program started recording outcomes in a standardized way in 2015 using standardized definitions and patient-reported outcome and experience measures. ↗
▶ Ep 7 · 11:32
clinical The bowel management study measured outcomes at one year rather than one week because one-week outcomes represent an artificial environment, and one-year measurement demonstrates sustained changes within the patient's normal environment. ↗
▶ Ep 7 · 11:59
quote But what we were able to show in the study was that if you look at the kids who were clean, their quality of life significantly improved. And if you look at the kids that are not clean, their quality of life did not improve at all. ↗
▶ Ep 7 · 11:59
clinical In the bowel management program, children who achieved continence had significantly improved quality of life, while those who remained incontinent had no quality of life improvement. ↗
▶ Ep 7 · 12:29
quote It's very sobering to realize that although you throw all these resources at these patients, you have a cohort of 30% that you have not improved their quality of life and that they're still having accidents. ↗
▶ Ep 7 · 12:56
clinical In the bowel management study, 70% of children achieve good outcomes, allowing focus on understanding and improving outcomes for the remaining 30%. ↗