Shamael Elam

69 statements · 2 topics

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Implant the metrofenoff very carefully and then see where the malone goes. If you try and push the alone to the umbilicus after you've implanted the metrofenoff, you're limited by your blood supply, and there have been reports of it ripping.
quote · Anorectal Malformation
You have to remember that patients who tend to get to the point where they need a vesicostomy probably have some impairment in bladder function, and there may be a risk that those patients would then need intermittent catheterization.
quote · Anorectal Malformation
The creatinine may be 0.3 for the 1st 12 months of life or 18 months of life, but the child could be at the 4th percentile for height and weight. That's not a normal condition.
quote · Colorectal / ARM & Hirschsprung
The appendix makes a really nice metrofenoff that tends to have a little bit longer, uh, durability, so to speak, than a tapered, uh, ileal piece for uh metrofenov.
quote · Colorectal / ARM & Hirschsprung

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Shamael's statements about Anorectal Malformation 23 statements

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Urologic and Gynecologic Aspects in Anorectal Malformations: Pediatric...

Statement A voiding cystourethrogram showing high-grade reflux with ureteral dilation, tortuosity, and renal pelvis dilation indicates a child at relatively high risk who should be followed closely and warrants urologic evaluation. Open
Quotation This is a child who is at relatively high risk, and this is a child that should be followed pretty, pretty closely and definitely it warrants a urologic evaluation. Open
Statement Solitary kidney patients are at higher risk for further injury of that solitary kidney, generally in the case of unrecognized or underdiagnosed neurogenic bladder. Open
Statement In ARM patients at risk with solitary kidney, height and weight growth and development are very important to track—a creatinine of 0.3 may be normal but a child at the 4th percentile for height and weight is not normal. Open
Quotation The creatinine may be 0.3 for the 1st 12 months of life or 18 months of life, but the child could be at the 4th percentile for height and weight. That's not a normal condition. Open
Statement A 12-year-old ex-cloaca repair patient who is voiding well, has urinary control, and no UTIs may still have underlying neuropathic bladder that could lead to renal failure by age 30. Open
Quotation The morbidity is the functional morbidity. The structural morbidity is something everyone in the room can see. Open
Statement Neuropathic bladder does not always mean the patient leaks or has urinary tract infections—there are subtleties requiring renal function studies (cystatin C) to assess GFR and overall kidney health. Open
Quotation A neuropathic bladder doesn't mean that they leak. It doesn't always mean that they have urinary tract infections, and there's some subtleties. Open
Statement ARM patients with bladder neck fistula, single kidney, reflux, and tethered cord are at high risk for neurogenic bladder, and expectations should not be set for volitional voiding. Open
Quotation Expectations should not be set in terms of volitional voiding in that patient population. It's nice to be wrong, and let's say they have volitional voiding and they're healthy, that's great, then we're wrong. Open
Quotation I can tell you based on the number of patients that are seeing me, especially in their 20s and 30s, um, I don't think we're right. Open
Statement The split appendix technique uses the proximal appendix (closest to cecum) for Malone and the distal appendix for Mitrofanoff. Open
Statement Even if a child has malrotation, the appendix should not be removed electively in ARM patients because it may be needed for Mitrofanoff or Malone. Open
Quotation The appendix makes a really nice metrofenoff that tends to have a little bit longer, uh, durability, so to speak, than a tapered, uh, ileal piece for uh metrofenov. Open
Statement The appendix makes a better Mitrofanoff with longer durability than a tapered ileal piece. Open
Statement When using split appendix technique, implant the Mitrofanoff first and then see where the Malone goes—pushing the Malone to the umbilicus after Mitrofanoff implantation can cause blood supply problems and reports of ripping. Open
Quotation Implant the metrofenoff very carefully and then see where the malone goes. If you try and push the alone to the umbilicus after you've implanted the metrofenoff, you're limited by your blood supply, and there have been reports of it ripping. Open
Statement Five centimeter common channel cloaca patients rarely have volitional voiding that is functional later in life. Open
Quotation I personally have no trouble dividing bladder necks and doing the reimplant, bringing down a vasicostomy, the time of flake repair for those 5 centimeter common channels because I really haven't seen any 5 centimeter common channels with volitional voiding that are very. Open
Statement A circle stent (small 6 or 8 French elastic catheter) that comes out of the urethral repair and bladder and ties to itself, protected with a suprapubic tube, allows 100% certainty about urethral healing and avoids a perineal catheter that can be pulled. Open
Statement Patients who need vesicostomy probably have some impairment in bladder function and may need intermittent catheterization. Open
Quotation You have to remember that patients who tend to get to the point where they need a vesicostomy probably have some impairment in bladder function, and there may be a risk that those patients would then need intermittent catheterization. Open
Shamael's statements about Colorectal / ARM & Hirschsprung 46 statements

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Urologic and Gynecologic Aspects in Anorectal Malformations: Pediatric...

Statement A voiding cystourethrogram showing high-grade reflux with ureteral dilation, tortuosity, and renal pelvis dilation indicates a child at relatively high risk who should be followed closely and warrants urologic evaluation. Open
Statement A voiding cystourethrogram showing high-grade reflux with ureteral dilation, tortuosity, and renal pelvis dilation indicates a child at relatively high risk who should be followed closely and warrants urologic evaluation. Open
Quotation This is a child who is at relatively high risk, and this is a child that should be followed pretty, pretty closely and definitely it warrants a urologic evaluation. Open
Quotation This is a child who is at relatively high risk, and this is a child that should be followed pretty, pretty closely and definitely it warrants a urologic evaluation. Open
Statement Solitary kidney patients are at higher risk for further injury of that solitary kidney, generally in the case of unrecognized or underdiagnosed neurogenic bladder. Open
Statement Solitary kidney patients are at higher risk for further injury of that solitary kidney, generally in the case of unrecognized or underdiagnosed neurogenic bladder. Open
Statement In ARM patients at risk with solitary kidney, height and weight growth and development are very important to track—a creatinine of 0.3 may be normal but a child at the 4th percentile for height and weight is not normal. Open
Statement In ARM patients at risk with solitary kidney, height and weight growth and development are very important to track—a creatinine of 0.3 may be normal but a child at the 4th percentile for height and weight is not normal. Open
Quotation The creatinine may be 0.3 for the 1st 12 months of life or 18 months of life, but the child could be at the 4th percentile for height and weight. That's not a normal condition. Open
Quotation The creatinine may be 0.3 for the 1st 12 months of life or 18 months of life, but the child could be at the 4th percentile for height and weight. That's not a normal condition. Open
Statement A 12-year-old ex-cloaca repair patient who is voiding well, has urinary control, and no UTIs may still have underlying neuropathic bladder that could lead to renal failure by age 30. Open
Statement A 12-year-old ex-cloaca repair patient who is voiding well, has urinary control, and no UTIs may still have underlying neuropathic bladder that could lead to renal failure by age 30. Open
Quotation The morbidity is the functional morbidity. The structural morbidity is something everyone in the room can see. Open
Quotation The morbidity is the functional morbidity. The structural morbidity is something everyone in the room can see. Open
Quotation A neuropathic bladder doesn't mean that they leak. It doesn't always mean that they have urinary tract infections, and there's some subtleties. Open
Statement Neuropathic bladder does not always mean the patient leaks or has urinary tract infections—there are subtleties requiring renal function studies (cystatin C) to assess GFR and overall kidney health. Open
Statement Neuropathic bladder does not always mean the patient leaks or has urinary tract infections—there are subtleties requiring renal function studies (cystatin C) to assess GFR and overall kidney health. Open
Quotation A neuropathic bladder doesn't mean that they leak. It doesn't always mean that they have urinary tract infections, and there's some subtleties. Open
Statement ARM patients with bladder neck fistula, single kidney, reflux, and tethered cord are at high risk for neurogenic bladder, and expectations should not be set for volitional voiding. Open
Statement ARM patients with bladder neck fistula, single kidney, reflux, and tethered cord are at high risk for neurogenic bladder, and expectations should not be set for volitional voiding. Open
Quotation Expectations should not be set in terms of volitional voiding in that patient population. It's nice to be wrong, and let's say they have volitional voiding and they're healthy, that's great, then we're wrong. Open
Quotation Expectations should not be set in terms of volitional voiding in that patient population. It's nice to be wrong, and let's say they have volitional voiding and they're healthy, that's great, then we're wrong. Open
Quotation I can tell you based on the number of patients that are seeing me, especially in their 20s and 30s, um, I don't think we're right. Open
Quotation I can tell you based on the number of patients that are seeing me, especially in their 20s and 30s, um, I don't think we're right. Open
Statement The split appendix technique uses the proximal appendix (closest to cecum) for Malone and the distal appendix for Mitrofanoff. Open
Statement The split appendix technique uses the proximal appendix (closest to cecum) for Malone and the distal appendix for Mitrofanoff. Open
Statement Even if a child has malrotation, the appendix should not be removed electively in ARM patients because it may be needed for Mitrofanoff or Malone. Open
Statement Even if a child has malrotation, the appendix should not be removed electively in ARM patients because it may be needed for Mitrofanoff or Malone. Open
Statement The appendix makes a better Mitrofanoff with longer durability than a tapered ileal piece. Open
Quotation The appendix makes a really nice metrofenoff that tends to have a little bit longer, uh, durability, so to speak, than a tapered, uh, ileal piece for uh metrofenov. Open
Statement The appendix makes a better Mitrofanoff with longer durability than a tapered ileal piece. Open
Quotation The appendix makes a really nice metrofenoff that tends to have a little bit longer, uh, durability, so to speak, than a tapered, uh, ileal piece for uh metrofenov. Open
Statement When using split appendix technique, implant the Mitrofanoff first and then see where the Malone goes—pushing the Malone to the umbilicus after Mitrofanoff implantation can cause blood supply problems and reports of ripping. Open
Statement When using split appendix technique, implant the Mitrofanoff first and then see where the Malone goes—pushing the Malone to the umbilicus after Mitrofanoff implantation can cause blood supply problems and reports of ripping. Open
Quotation Implant the metrofenoff very carefully and then see where the malone goes. If you try and push the alone to the umbilicus after you've implanted the metrofenoff, you're limited by your blood supply, and there have been reports of it ripping. Open
Quotation Implant the metrofenoff very carefully and then see where the malone goes. If you try and push the alone to the umbilicus after you've implanted the metrofenoff, you're limited by your blood supply, and there have been reports of it ripping. Open
Quotation I personally have no trouble dividing bladder necks and doing the reimplant, bringing down a vasicostomy, the time of flake repair for those 5 centimeter common channels because I really haven't seen any 5 centimeter common channels with volitional voiding that are very. Open
Statement Five centimeter common channel cloaca patients rarely have volitional voiding that is functional later in life. Open
Statement Five centimeter common channel cloaca patients rarely have volitional voiding that is functional later in life. Open
Quotation I personally have no trouble dividing bladder necks and doing the reimplant, bringing down a vasicostomy, the time of flake repair for those 5 centimeter common channels because I really haven't seen any 5 centimeter common channels with volitional voiding that are very. Open
Statement A circle stent (small 6 or 8 French elastic catheter) that comes out of the urethral repair and bladder and ties to itself, protected with a suprapubic tube, allows 100% certainty about urethral healing and avoids a perineal catheter that can be pulled. Open
Statement A circle stent (small 6 or 8 French elastic catheter) that comes out of the urethral repair and bladder and ties to itself, protected with a suprapubic tube, allows 100% certainty about urethral healing and avoids a perineal catheter that can be pulled. Open
Quotation You have to remember that patients who tend to get to the point where they need a vesicostomy probably have some impairment in bladder function, and there may be a risk that those patients would then need intermittent catheterization. Open
Quotation You have to remember that patients who tend to get to the point where they need a vesicostomy probably have some impairment in bladder function, and there may be a risk that those patients would then need intermittent catheterization. Open
Statement Patients who need vesicostomy probably have some impairment in bladder function and may need intermittent catheterization. Open
Statement Patients who need vesicostomy probably have some impairment in bladder function and may need intermittent catheterization. Open