Surgical Management and Follow-Up: Cloaca and Complex ARMs 2015

Continence is not necessarily a measure of a healthy bladder or healthy upper tracts.

Voiding may in fact be possible, but in some cases voiding can actually be harmful.

When children are born, at one month of age they have about 30 to 40% of their actual adult GFR; GFR is still developing.

A successful voiding trial is not predictive of future health.

Bladder management to protect upper tract injury is recommended, not simply catheterization or not catheterization.

Yearly measurement of GFR and blood pressure measurement are advised.

Delayed urinary control is not normal in anorectal malformation.

Urinary tract infection is not normal in anorectal malformation.

Urodynamics are highly dependent on the operator and the information gleaned is not necessarily what is expected.

Incontinence, volitional stream, or strong urinary stream does not necessarily mean that children are healthy, nor does it suggest the absence of a problem.

A lot of information can be gleaned from a simple ultrasound as well as a VCUG, especially in the below 12 month age group.

High pressure voiding is actually normal in the under 12 months of age cohort, so urodynamics may not give the information you're looking for.

The trigone is the part of the anatomy that's altered, especially with separation.

In anorectal malformations with cloaca, there typically is no external sphincter, so that's not easy to test with urodynamics.

The function of the intrinsic sphincter is not necessarily easy to test with urodynamics.

Catheterizing long common channels long term is not always without complications.

Patients with posterior cloaca have the single perineal orifice posteriorly deviated instead of at the normal urethral location, so you can even think the patient has a normal anus.

Posterior cloaca patients have a very short common channel and a very thick pubic bone, making it a challenge to have the three structures, but the actual mobilization is not usually difficult.

From 560 cloacas in a personal series, the spectrum of defects goes from very short to very long common channels, tethered cord to normal cord, normal to abnormal sacrum, born with or without hydronephrosis, with or without reflux.

Some patients have a giant bladder even since birth with low pressure at birth; some others have a small bladder; some patients switch from big bladder to a small hypertonic bladder.