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Posterior Cloaca: A Unique Defect
PEDIATRIC UROLOGY
rather than via an abdominal stoma is emphasized in this article to explain the importance of this technically difficult procedure. Douglas A. Canning, M.D.
Posterior Cloaca: A Unique Defect
A. PEAAAND 0. KESSLER, Departments of Surgery and Urology, Division of Pediatric Surgery, Long Island Jewish Medical Center, New Hyde Park and Clinical Campus of Albert Einstein College of Medicine, Bronx, New York J. Ped. Surg., 33: 407-412,1998 Permission to Publish Abstract Not Granted Editorial Comment: The authors describe a variation of the cloacal defect in 9 of 170 primary cases of persistent cloaca. In these patients the urethra and vagina are fused to form a urogenital sinus that deviates posteriorly and opens in the anterior rectal wall at the anus or immediately anterior to it. Of these patients 8 had renal or ureteral defects, including unilateral renal agenesis, vesicoureteral reflux or ureteral obstruction. Because the rectum is normally located with a normal sphincter mechanism, the urethral and vaginal anomaly is repaired through a posterior sagittal transanorectal approach. The vagina and urethra are mobilized en bloc and moved anterior to a normal position just posterior to the pubis. Of these 9 patients 6 are continent of urine and stool without bladder neck surgery, suggesting that the bladder neck is normal in most of these children. The authors believe that splitting rather than retracting the rectum provides better exposure in this dissection without increasing morbidity. Douglas A. Canning, M.D.
Gynecologic Concerns in the Treatment of Teenagers With Cloaca
M. A. LEVI-IT, D. M. STEIN AND A. PEAA, Department of Surgery, Division of Pediatric Surgery, Long Island Jewish Medical Center, New Hyde Park and Clinical Campus of Albert Einstein College of Medicine, Bronx, New York J. Ped. Surg., 3 3 188-193, 1998 Permission to Publish Abstract Not Granted Editorial Comment: In this series 22 of 198 patients who underwent operations for cloaca are now of postpubertal age. Only 7 patients are normally menstruating, all of whom had symmetrical gynecological anatomy at the initial surgery to reconstruct the cloaca. In 6 patients the uterus is absent or atretic, and 9 have abdominal pain and cystic abdominal masses requiring drainage or resection of inflamed hemiuteri, tubes or blind vaginas. Most of these girls had 1or more miillerian structures that interfered with drainage of menstrual blood. Asymmetric uterine anatomy or a vaginal atresia in the neonatal period correlated with future obstruction. The authors recommend addressing the abnormal vaginal, uterine or fallopian anatomy during the initial surgery for the cloaca. Despite the obvious advantages of correcting the abnormal anatomy in infancy, it is sometimes difficult to predict the future drainage of the bifid or duplicated uterus, which makes removal of all but the most atretic uterus impractical in infancy. As children with persistent cloaca reach puberty, close followup is essential to provide prompt resection or drainage of the uterus before infection jeopardizes function of the residual uterine structures. Douglas A. Canning, M.D.
Scrotal Involvement in Henoch-Schonlein Purpura in Children
C. 0. MINTZER, M. NUSSINOVITCH, Y. DANZIGER, M. MIMOUNI LVD 1. VAI~SANO,Department of Pediatrics B and C, Schneider Children's Medical Center of Israel, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Scand. J. Urol. Nephrol., 32: 138-139, 1998 Different rates of scrotal involvement in Henoch-Schonlein purpura (HSP) have been reported. We assessed scrotal involvement in 86 children over a 20-year period: 10 patients suffered from scrotal involvement and 9 of them also had arthritis. The possible association between scrotal involvement and arthritis may help the physician in the differential diagnosis of atypical presentations.
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rather than via an abdominal stoma is emphasized in this article to explain the importance of this technically difficult procedure. Douglas A. Canning, M.D.
Posterior Cloaca: A Unique Defect
A. PEAAAND 0. KESSLER, Departments of Surgery and Urology, Division of Pediatric Surgery, Long Island Jewish Medical Center, New Hyde Park and Clinical Campus of Albert Einstein College of Medicine, Bronx, New York J. Ped. Surg., 33: 407-412,1998 Permission to Publish Abstract Not Granted Editorial Comment: The authors describe a variation of the cloacal defect in 9 of 170 primary cases of persistent cloaca. In these patients the urethra and vagina are fused to form a urogenital sinus that deviates posteriorly and opens in the anterior rectal wall at the anus or immediately anterior to it. Of these patients 8 had renal or ureteral defects, including unilateral renal agenesis, vesicoureteral reflux or ureteral obstruction. Because the rectum is normally located with a normal sphincter mechanism, the urethral and vaginal anomaly is repaired through a posterior sagittal transanorectal approach. The vagina and urethra are mobilized en bloc and moved anterior to a normal position just posterior to the pubis. Of these 9 patients 6 are continent of urine and stool without bladder neck surgery, suggesting that the bladder neck is normal in most of these children. The authors believe that splitting rather than retracting the rectum provides better exposure in this dissection without increasing morbidity. Douglas A. Canning, M.D.
Gynecologic Concerns in the Treatment of Teenagers With Cloaca
M. A. LEVI-IT, D. M. STEIN AND A. PEAA, Department of Surgery, Division of Pediatric Surgery, Long Island Jewish Medical Center, New Hyde Park and Clinical Campus of Albert Einstein College of Medicine, Bronx, New York J. Ped. Surg., 3 3 188-193, 1998 Permission to Publish Abstract Not Granted Editorial Comment: In this series 22 of 198 patients who underwent operations for cloaca are now of postpubertal age. Only 7 patients are normally menstruating, all of whom had symmetrical gynecological anatomy at the initial surgery to reconstruct the cloaca. In 6 patients the uterus is absent or atretic, and 9 have abdominal pain and cystic abdominal masses requiring drainage or resection of inflamed hemiuteri, tubes or blind vaginas. Most of these girls had 1or more miillerian structures that interfered with drainage of menstrual blood. Asymmetric uterine anatomy or a vaginal atresia in the neonatal period correlated with future obstruction. The authors recommend addressing the abnormal vaginal, uterine or fallopian anatomy during the initial surgery for the cloaca. Despite the obvious advantages of correcting the abnormal anatomy in infancy, it is sometimes difficult to predict the future drainage of the bifid or duplicated uterus, which makes removal of all but the most atretic uterus impractical in infancy. As children with persistent cloaca reach puberty, close followup is essential to provide prompt resection or drainage of the uterus before infection jeopardizes function of the residual uterine structures. Douglas A. Canning, M.D.
Scrotal Involvement in Henoch-Schonlein Purpura in Children
C. 0. MINTZER, M. NUSSINOVITCH, Y. DANZIGER, M. MIMOUNI LVD 1. VAI~SANO,Department of Pediatrics B and C, Schneider Children's Medical Center of Israel, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Scand. J. Urol. Nephrol., 32: 138-139, 1998 Different rates of scrotal involvement in Henoch-Schonlein purpura (HSP) have been reported. We assessed scrotal involvement in 86 children over a 20-year period: 10 patients suffered from scrotal involvement and 9 of them also had arthritis. The possible association between scrotal involvement and arthritis may help the physician in the differential diagnosis of atypical presentations.
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