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 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 ↗
Strictures were non-significant between both groups (dilation vs no dilation), and a Heineke-Mikulicz anoplasty (longitudinal incision closed transversely to widen diameter) was able to be performed for stricture management.
host_summaryRebecca Rentia2:26 ↗
The number of strictures, number needing anoplasties, and number of redo operations were the same between dilation and no-dilation groups.
host_summaryEllen Encisco2:55 ↗
The number of patients who had rectal prolapse is consistent with the literature.
host_summaryEllen Encisco3:04 ↗
Dr. Rentia currently sizes the anus at 2 weeks and 1 month in practice to understand the diameter of the anoplasty so that stooling is not obstructed by an unrecognized strictured anoplasty.
opinionRebecca Rentia3:19 ↗
Dr. Rentia would only consider initiating full dilations for slightly older children where dilations are more traumatic and if concerned about needing general anesthesia, given that HM anoplasty is an option.
opinionRebecca Rentia3:38 ↗
About 5 to 8% of patients require a strictureplasty at the two-month period.
epidemiologicalRebecca Rentia4:04 ↗
Dr. Rentia is a fan of doing dilations in the neonatal period for low malformations and having the family discharged as soon as possible to home.
opinionRebecca Rentia5:03 ↗
A study of 30-day outcomes for ARM with perineal or rectovaginal fistulas divided patients into early repair (before 6 days old) and late repair (6-8 weeks), with 66 early and 231 late repairs among 291 patients.
host_summaryEllen Encisco5:20 ↗
30-day complications are not statistically different between early and late repair groups for perineal and rectovaginal fistulas.
host_summaryCaitlin Smith5:40 ↗
A second study defined early repair as 14 days or younger and late as after 14 days, with 31 early and 133 late repairs among 164 patients, also showing no difference in 30-day complications.
host_summaryCaitlin Smith5:45 ↗
Dr. Smith finds that for neonates and infants up to several months old, dilations are really well tolerated, but avoids them in older age groups.
opinionCaitlin Smith6:22 ↗
Formula-fed infants who need caloric concentration have thicker stools, which might push toward earlier repair, while breastfed infants can delay until 2-3 months.
clinicalCaitlin Smith6:32 ↗
Repair should be done before infants start solids because that makes the dilation strategy at home much more difficult.
clinicalCaitlin Smith6:47 ↗
Long segment Hirschsprung disease is defined as any disease proximal to the rectosigmoid colon for the majority of reviewed articles.
host_summaryRebecca Rentia7:27 ↗
A contrast study itself is very inaccurate for Hirschsprung disease, and colonic mapping needs to be performed to determine the level of the transition zone.
host_summaryRebecca Rentia7:42 ↗
There was no superior or more common operation for long segment Hirschsprung, although Duhamel and Swenson-Soave were the top operations.
host_summaryRebecca Rentia7:51 ↗
There are no new novel surgical techniques for Hirschsprung disease over the past several years, though there is potential for stem cell therapy which is still in its infancy.
host_summaryRebecca Rentia8:13 ↗
A hypermotility and skin rash protocol for total colonic Hirschsprung disease outlines why an early operation (around 5 months old) is possible.
host_summaryRebecca Rentia8:31 ↗
If a child with an ileostomy is adequately prepared and the family can learn to thicken stool, they can have a pull-through that does not result in complete perineal skin breakdown and learn techniques helpful for this difficult-to-toilet-train group.
host_summaryRebecca Rentia8:49 ↗
Dr. Rentia performs pull-through when the child is toilet trained for urine, typically at age 4, because waiting too long can result in horrible anal sphincter spasm and pelvic disease that makes keeping a pull-through challenging.
opinionRebecca Rentia9:25 ↗
A PCPLC study on bowel management strategies in children with anorectal malformations looked at 624 patients in the 5-12 year old age group.
host_summaryCaitlin Smith10:36 ↗
Even mild and moderate anorectal malformation patients in the 5-12 year old group need to rely on enemas and other bowel management strategies to stay clean when heading into school age.
host_summaryCaitlin Smith10:45 ↗
The majority of ARM patients had constipation as their primary complaint, and only 40% were toilet trained.
host_summaryCaitlin Smith11:14 ↗
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