- Email: [email protected]
Re: Spinal Ultrasound in Patients with Anorectal Malformations: Is This the End of an Era?
Urological Survey Pediatric Urology Re: The “Rescue Operation” for Patients with Cloacal Exstrophy and its Variants ~a A. Bischoff, G. Brisighelli, M. A. Levitt and A. Pen Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio Pediatr Surg Int 2014; 30: 723e727.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.09.021 available at http://jurology.com/ Editorial Comment: These authors, who have tremendous experience with cloaca and cloacal exstrophy, report on 19 children who underwent a higher diversion (as opposed to an end colostomy) and who were converted from a more proximal ileostomy that previously left the distal colon defunctionalized to an end colostomy with complete separation of the colonic segment from the bladder. Of 66 patients in their series of cloacal exstrophy 9 who had previously undergone ileostomy or proximal colostomy were rediverted with refunctionalization of the distal ileum or colon. Of the 19 children 10 remained with the colostomy awaiting further reconstruction and possible pull-through, while 6 underwent pull-through after responding to a bowel management program and 2 will have a permanent stoma. One patient died. Following the “rescue operation” a number of patients had resolution of acidosis and improvement in weight gain. While most teams understand the importance of complete separation of the ileum and colon from the urinary tract in the management of cloacal exstrophy, this article provides additional evidence of the importance of the initial management. Douglas A. Canning, MD
Re: Spinal Ultrasound in Patients with Anorectal Malformations: Is This the End of an Era? F. Scottoni, B. D. Iacobelli, A. M. Zaccara, G. Totonelli, A. M. Schingo and P. Bagolan Children’s Hospital, Rome, Italy Department of Medical and Surgical Neonatology, Bambino Gesu Pediatr Surg Int 2014; 30: 829e831.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.09.022 available at http://jurology.com/ Editorial Comment: The authors reviewed all patients with anorectal malformations (ARMs), consisting of anal stenosis, rectoperineal fistula, rectovestibular fistula cloaca, imperforate anus, rectourethral fistula and rectovesical fistula, at their institution who underwent neonatal spinal ultrasound and subsequent magnetic resonance imaging (MRI) between 1999 and 2013. Of 244 patients with ARMs 82 underwent imaging studies and were included. Of these patients 18 females and 29 males had occult spinal dysraphism (tethered cord, spinal lipoma or syringomyelia) on MRI. In contrast, only 7 patients had spinal abnormalities on ultrasound. The authors conclude that neonatal ultrasound is a poor screening test for patients with anorectal malformations and recommend MRI in all patients with anorectal malformation. My impression is 0022-5347/15/1946-1748/0 THE JOURNAL OF UROLOGY® Ó 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
1748
j
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2015.09.021 Vol. 194, 1748-1750, December 2015 Printed in U.S.A.
PEDIATRIC UROLOGY
1749
that we do better with ultrasound than these authors but I will review this study with our neuroradiologists. Despite the convenience, if ultrasound is insensitive in identifying occult spinal dysraphism in this context, we may need to reconsider its use as a screening tool in infants with ARM. Douglas A. Canning, MD
Re: Sexual Function and Health-Related Quality of Life in Women with Classic Bladder Exstrophy R. Deans, L. M. Liao, D. Wood, C. Woodhouse and S. M. Creighton University of New South Wales and Royal Hospital for Women, Sydney, Australia BJU Int 2015; 115: 633e638.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.09.023 available at http://jurology.com/ Editorial Comment: In this long-term questionnaire based study of women with classic bladder exstrophy the authors sought to assess female sexual function, vaginal perception and overall health status across 5 dimensions. They used 3 standardized questionnaires in 44 patients who were identified from departmental databases, of whom 28 completed the questionnaires. The authors note a relatively normal overall health score, yet the sexual function index revealed considerably lower desire, arousal, lubrication, orgasm and satisfaction, and higher pain in the female sexual function index, and nearly half of respondents perceived the angle of the vagina as not right or obvious to their partner. Long-term followup studies like this one drive our passion for further improvement in the care of girls born with bladder exstrophy. Douglas A. Canning, MD
Re: Modified Penile Disassembly Technique for Boys with Epispadias and Those Undergoing Complete Primary Repair of Exstrophy: Long-Term Outcomes A. Z. Anwar, M. A. Mohamed, A. Hussein and A. M. Shaaban Department of Urology, Faculty of Medicine, El-Minia University, El-Minia, Egypt Int J Urol 2014; 21: 936e940.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.09.024 available at http://jurology.com/ Editorial Comment: The authors present their results in 34 boys who underwent the modified penile disassembly technique at their institution. Their modified technique includes a complete mobilization, similar to the Ransley technique, that leaves the urethral plate attached to the glans.1 The authors believe that their modification has resulted in less risk of glans injury with good results. Douglas A. Canning, MD 1. Ransley PG, Duffy PG and Wollin M: Bladder exstrophy closure and epispadias repair. In: Rob and Smith’s Operative Surgery: Pediatric Surgery, 4th ed. Edited by L Spitz and HH Nixon. Boston: Butterworths 1988; pp 620e622.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.09.021 available at http://jurology.com/ Editorial Comment: These authors, who have tremendous experience with cloaca and cloacal exstrophy, report on 19 children who underwent a higher diversion (as opposed to an end colostomy) and who were converted from a more proximal ileostomy that previously left the distal colon defunctionalized to an end colostomy with complete separation of the colonic segment from the bladder. Of 66 patients in their series of cloacal exstrophy 9 who had previously undergone ileostomy or proximal colostomy were rediverted with refunctionalization of the distal ileum or colon. Of the 19 children 10 remained with the colostomy awaiting further reconstruction and possible pull-through, while 6 underwent pull-through after responding to a bowel management program and 2 will have a permanent stoma. One patient died. Following the “rescue operation” a number of patients had resolution of acidosis and improvement in weight gain. While most teams understand the importance of complete separation of the ileum and colon from the urinary tract in the management of cloacal exstrophy, this article provides additional evidence of the importance of the initial management. Douglas A. Canning, MD
Re: Spinal Ultrasound in Patients with Anorectal Malformations: Is This the End of an Era? F. Scottoni, B. D. Iacobelli, A. M. Zaccara, G. Totonelli, A. M. Schingo and P. Bagolan Children’s Hospital, Rome, Italy Department of Medical and Surgical Neonatology, Bambino Gesu Pediatr Surg Int 2014; 30: 829e831.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.09.022 available at http://jurology.com/ Editorial Comment: The authors reviewed all patients with anorectal malformations (ARMs), consisting of anal stenosis, rectoperineal fistula, rectovestibular fistula cloaca, imperforate anus, rectourethral fistula and rectovesical fistula, at their institution who underwent neonatal spinal ultrasound and subsequent magnetic resonance imaging (MRI) between 1999 and 2013. Of 244 patients with ARMs 82 underwent imaging studies and were included. Of these patients 18 females and 29 males had occult spinal dysraphism (tethered cord, spinal lipoma or syringomyelia) on MRI. In contrast, only 7 patients had spinal abnormalities on ultrasound. The authors conclude that neonatal ultrasound is a poor screening test for patients with anorectal malformations and recommend MRI in all patients with anorectal malformation. My impression is 0022-5347/15/1946-1748/0 THE JOURNAL OF UROLOGY® Ó 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
1748
j
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2015.09.021 Vol. 194, 1748-1750, December 2015 Printed in U.S.A.
PEDIATRIC UROLOGY
1749
that we do better with ultrasound than these authors but I will review this study with our neuroradiologists. Despite the convenience, if ultrasound is insensitive in identifying occult spinal dysraphism in this context, we may need to reconsider its use as a screening tool in infants with ARM. Douglas A. Canning, MD
Re: Sexual Function and Health-Related Quality of Life in Women with Classic Bladder Exstrophy R. Deans, L. M. Liao, D. Wood, C. Woodhouse and S. M. Creighton University of New South Wales and Royal Hospital for Women, Sydney, Australia BJU Int 2015; 115: 633e638.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.09.023 available at http://jurology.com/ Editorial Comment: In this long-term questionnaire based study of women with classic bladder exstrophy the authors sought to assess female sexual function, vaginal perception and overall health status across 5 dimensions. They used 3 standardized questionnaires in 44 patients who were identified from departmental databases, of whom 28 completed the questionnaires. The authors note a relatively normal overall health score, yet the sexual function index revealed considerably lower desire, arousal, lubrication, orgasm and satisfaction, and higher pain in the female sexual function index, and nearly half of respondents perceived the angle of the vagina as not right or obvious to their partner. Long-term followup studies like this one drive our passion for further improvement in the care of girls born with bladder exstrophy. Douglas A. Canning, MD
Re: Modified Penile Disassembly Technique for Boys with Epispadias and Those Undergoing Complete Primary Repair of Exstrophy: Long-Term Outcomes A. Z. Anwar, M. A. Mohamed, A. Hussein and A. M. Shaaban Department of Urology, Faculty of Medicine, El-Minia University, El-Minia, Egypt Int J Urol 2014; 21: 936e940.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.09.024 available at http://jurology.com/ Editorial Comment: The authors present their results in 34 boys who underwent the modified penile disassembly technique at their institution. Their modified technique includes a complete mobilization, similar to the Ransley technique, that leaves the urethral plate attached to the glans.1 The authors believe that their modification has resulted in less risk of glans injury with good results. Douglas A. Canning, MD 1. Ransley PG, Duffy PG and Wollin M: Bladder exstrophy closure and epispadias repair. In: Rob and Smith’s Operative Surgery: Pediatric Surgery, 4th ed. Edited by L Spitz and HH Nixon. Boston: Butterworths 1988; pp 620e622.