Rectal Bladder Neck Fistula
Everything in the library about rectal bladder neck fistula — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Evidence & Research
2 items
Update Course Rewind: Pediatric Colorectal Consortium 2021
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Did you miss the Pediatric Colorectal and Pelvic Learning Consortium session from our 2021 Pediatric Surgery Update Course? Don’t worry, in this Update Course Rewind Dr. Rebecca Rentea from Children's Mercy at Kansas City and Dr. Caitlin Sm
podcast14:55 · Apr 2022
Update Course 2021: PEDS COLORECTAL CONSORTIUM CONCLUSIONS
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In this session from the 2021 Update Course, Dr. Rebecca Rentea, MD from Children's Mercy at KansasCity and Dr. Caitlin Smith, MD from Seattle Children's reviewed the latest literature including timing of surgery for patients with ARM and t
video36:32 · May 2022
Emerging & Future Directions
1 item
Update Course 2023 - Updates in Colorectal Pathology
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This session is on Updates in Colorectal Pathology with Drs. Caitlin Smith & Julia Grabowski.
The 11th Annual Pediatric Surgery Update Course was held on August 29, 2023 in Cleveland, Ohio and was livestreamed to a global audience. Th
video27:42 · Oct 2023
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Update Course 2023 - Updates in Colorectal Pathology
A 2021 prospective randomized controlled trial from Nationwide Children's Hospital compared dilated vs non-dilated groups after primary PSARP in patients under 2 years old with 12-month follow-up
clinicalCaitlin Smith3:17 ↗
Stricture rates were 3/25 in the dilated group and 8/25 in the non-dilated group, but only 3 patients in the non-dilated group required a separate anesthetic for strictureplasty
clinicalCaitlin Smith4:20 ↗
Strictureplasty is appropriate only for skin-level strictures, not for longer or deeper strictures which require redo operations
clinicalCaitlin Smith5:31 ↗
Strictureplasty for skin-level stricture takes approximately 20 minutes, patients can usually go home same day, and no dilations are performed after the procedure
clinicalJulia Groski6:29 ↗
Babies under 6 months generally tolerate dilations well, but patients over 6-12 months often have unsuccessful dilations and may develop strictures anyway
clinicalCaitlin Smith7:02 ↗
A prospective observational trial through the Pediatric Colorectal and Pelvic Learning Consortium will begin in the next few months to follow patients and describe findings regarding dilation practices
guidelineCaitlin Smith8:23 ↗
Strictures can develop in both dilated and non-dilated groups due to tension, ischemia, or reaction between epidermis and mucosa creating a band at the suture anastomosis
clinicalCaitlin Smith10:44 ↗
Keith Jorgeson taught that if you don't dilate at 2 weeks in the office, you're going to be hosed for a stricture
opinionJulia Groski12:10 ↗
In resource-limited settings where patients cannot afford to return for additional surgery, routine dilations may be more appropriate to prevent strictures requiring reoperation
opinion12:38 ↗
The standard Botox technique is 100 units in 1 mL saline, injected in 3-4 aliquots at the dentate line, avoiding anterior injection to protect the genitourinary tract
clinicalJulia Groski16:42 ↗
Many pharmacies will indicate that 100 units of Botox is above weight-based dosing for pediatric patients, but this dose has been shown to be safe
clinicalCaitlin Smith17:29 ↗
Every baby with Hirschsprung disease has a poorly functioning sphincter by nature of the disease
clinicalJulia Groski19:18 ↗
Babies with Hirschsprung disease generally outgrow enterocolitis as their external sphincter matures and overcomes the internal sphincter, assuming no mechanical obstruction and complete resection of aganglionic bowel
clinicalJulia Groski19:27 ↗
All Hirschsprung physiology sets up the colon to act like a pond with poor emptying and motility issues, allowing bacterial overgrowth if the colon is not cleared diligently
clinicalCaitlin Smith20:11 ↗
There is a significantly higher rate of enterocolitis in total colon Hirschsprung disease after pull-through compared to shorter segment disease
epidemiologicalJulia Groski21:09 ↗
Children with trisomy 21 have a much higher rate of enterocolitis after Hirschsprung pull-through without a well-understood explanation
epidemiologicalJulia Groski21:26 ↗
Enterocolitis in a diverted colon is theoretically possible with a tight stoma that doesn't empty well, though rarely seen in practice
clinicalJulia Groski22:33 ↗
There is discussion of whether colectomy should be performed at the time of total colon Hirschsprung diagnosis due to enterocolitis risk, but waiting for final pathology is recommended to avoid unnecessary colectomy
opinionJulia Groski22:55 ↗
Prophylactic Botox has not been shown to decrease the risk of enterocolitis in Hirschsprung patients
clinicalJulia Groski24:01 ↗
Botox has been shown to decrease length of stay in patients admitted for enterocolitis and potentially decrease hospitalizations in patients with recurrent obstruction or enterocolitis
clinicalJulia Groski24:25 ↗
Two variations of perineal body-sparing PSARP have been published in the last 6 months, one from Boston and one from DC, with slightly different techniques
clinicalCaitlin Smith25:48 ↗
The perineal body is important for sexual function and obstetric outcomes in female patients
clinicalCaitlin Smith26:22 ↗
Perineal body-sparing techniques reduce the risk of postoperative infection in patients undergoing dilations who are not diverted, as the perineal body seeing stool immediately is a setup for infection
clinicalJulia Groski27:12 ↗
Update Course Rewind: Pediatric Colorectal Consortium 2021
A single institution prospective randomized controlled trial found that anal dilations after PSARP may not be needed.
host_summaryRebecca Rentia1:10 ↗
There is literature suggesting a component of psychosocial, psychological dissociation in children on later testing related to anal dilations.
host_summaryEllen Encisco1:31 ↗
In the dilation study, length of follow-up was 12 months, PSARP had to be performed in a child under 24 months of age, it was primary surgery, and excluded cloaca as a diagnosis.
host_summaryRebecca Rentia1:37 ↗
The average PSARP was performed at 5 months in the study.
host_summaryRebecca Rentia1:50 ↗
A stricture was defined as a Hagar dilator size of less than 10.
host_summaryRebecca Rentia1:52 ↗
The standard Hagar dilator size for a newborn is about size 12, so a size 10 is 2 deviations less.
host_summaryTodd Ponsky1:57 ↗
In the dilation study with 25 children, the types of malformations were evenly distributed and complexity was about equal.
host_summaryTodd Ponsky2:16 ↗
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