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Center for Colorectal and Pelvic Reconstruction

Surgical Repair of Cloacal Malformation Does Not Worsen Bladder Function
 Surgical Repair of Cloacal Malformation Does Not Worsen Bladder Function 1024 683 Mary Bates, PhD
By: Mary Bates, PhD

The complexity of the malformation, more than the surgical approach, determines post-operative urodynamics. Approximately 90% of girls with cloacal malformation exhibit some degree of bladder dysfunction. While associated conditions can impact bladder dynamics, the complex surgery required to repair cloacal malformation has also been hypothesized to cause bladder dysfunction. Strategies to repair cloacal malformation in…

Sacral Nerve Stimulation Improves Symptoms and Quality of Life in Children With Defecation Disorders
 Sacral Nerve Stimulation Improves Symptoms and Quality of Life in Children With Defecation Disorders 1024 656 Mary Bates, PhD
By: Mary Bates, PhD

A new study narrows down the patients who may benefit the most from the treatment. In a large prospective study, researchers from Nationwide Children’s Hospital found that sacral nerve stimulation can lead to significant and long-lasting improvements in fecal continence and quality of life in children with refractory defecation disorders. Sacral nerve stimulation (SNS) involves…

Long-Term Bladder Management and Continence in Girls With Cloacal Malformation
 Long-Term Bladder Management and Continence in Girls With Cloacal Malformation 1024 683 Pam Georgiana
By: Pam Georgiana
Molly Fuchs, MD

New insights on outcomes and quality of life from Nationwide Children’s comprehensive study of pediatric patients. Over the last decade, surgical innovation has revolutionized the treatment of cloacal malformation, a congenital anomaly affecting the development of the gastrointestinal, urinary and reproductive systems in girls. This condition occurs when the rectum, vagina and urinary tracts fail…

Outcomes of Colonic Pull-Through for Patients With Cloacal Exstrophy: Is it Really Helping Kids?
 Outcomes of Colonic Pull-Through for Patients With Cloacal Exstrophy: Is it Really Helping Kids? 1024 683 Mary Bates, PhD
By: Mary Bates, PhD

Collaborative study reveals infrequent utilization of the procedure and identifies factors correlated with success. Cloacal exstrophy is a rare grouping of congenital anorectal malformations. Although once nearly uniformly fatal, survival has increased significantly, and with it, the focus on long-term outcomes. In the last 15 years, a reconstructive surgery known as colonic pull-through has been…

Straightforward Stitch Technique Dramatically Reduces Post-Operative Anorectoplasty Complications
 Straightforward Stitch Technique Dramatically Reduces Post-Operative Anorectoplasty Complications 150 150 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

The novel para-U-stitch keeps post-operative wound dehiscence to a minimum, helping patients with anorectal malformations avoid readmission, reoperation and infection. After recognizing a pattern of wound dehiscence and postoperative complications in patients with anorectal malformations (ARMs) repaired without a colostomy bag — meaning they stool directly through the surgical site as it heals — surgeons…

Study Shows 1 in 4 Girls Born With Anorectal Malformations Have Co-occurring Gynecologic Anomalies
 Study Shows 1 in 4 Girls Born With Anorectal Malformations Have Co-occurring Gynecologic Anomalies 1024 575 Jessica Nye, PhD
By: Jessica Nye, PhD

Gynecological anomalies are common among girls with anorectal malformations (ARM) with or without associated vertebral, anorectal, cardiovascular, trachea-esophageal, renal and limb (VACTERL) anomalies. One in 5,000 live births have ARM and 20%-70% co-occur with other congenital anomalies, including VACTERL. For girls born with ARM, gynecologic congenital anomalies can occur, especially with more complex ARM. To…

Which Surgical Approach for Catheterizable Channels in Bowel and Bladder Management Is Best?
 Which Surgical Approach for Catheterizable Channels in Bowel and Bladder Management Is Best? 150 150 Jessica Nye, PhD
By: Jessica Nye, PhD

Specific patient characteristics, such as appendix size, may help guide clinicians when deciding which surgical approach to use for patients in need of catheterizable channels for bladder and bowel management. Many patients with neurologic disorders experience urinary and fecal incontinence. The appendix or the transverse ileal tube can be repurposed as a catheterizable channel to…

High Rate of Urologic Anomalies in Children With Anorectal Malformations
 High Rate of Urologic Anomalies in Children With Anorectal Malformations 150 150 Lauren Dembeck
By: Lauren Dembeck

Early recognition of urologic problems through proactive screening and urologic collaboration may help prevent of renal deterioration and allow for timely treatment in this population.   Researchers at Nationwide Children’s Hospital have recently demonstrated that urologic anomalies occur at a high rate in children with anorectal malformations and appear to increase in frequency with increasing…

A New Kind of Rectal Diversion in Classic Bladder Exstrophy
 A New Kind of Rectal Diversion in Classic Bladder Exstrophy 1024 754 Jeb Phillips
By: Jeb Phillips

  This article appeared in the Spring/Summer 2021 print issue. Download the full issue.   Medical illustrations by Mandy Root-Thompson for Nationwide Children’s Hospital Source: V. Rama Jayanthi, chief of Urology at Nationwide Children’s Hospital To learn more about the procedure and it’s applications, read A Surprising Approach to Classic Bladder Exstrophy.

Does Low Baseline Renal Volume Lead to Renal Insufficiency in Children With Cloacal Anomalies?
 Does Low Baseline Renal Volume Lead to Renal Insufficiency in Children With Cloacal Anomalies? 1024 683 Lauren Dembeck
By: Lauren Dembeck

According to the results of a recent study published in Urology, children with cloacal anomalies have baseline renal volumes similar to those of children without cloacal anomalies, indicating that the increased risk of renal insufficiency in children with cloacal anomalies appears to be due to postnatal renal injury. “Before we can determine if surgical interventions or…

Redo Surgery After Anorectal Malformation Repair Can Improve Functional Outcomes
 Redo Surgery After Anorectal Malformation Repair Can Improve Functional Outcomes 1024 575 Mary Bates, PhD
By: Mary Bates, PhD

A reoperation can improve continence and quality of life in children still struggling with fecal incontinence following ARM repair. In a new study, researchers from Nationwide Children’s Hospital show that redo surgeries are   safe and may be an effective option for patients with fecal incontinence after an anorectal malformation repair. For many patients, a reoperation…

Botox Appears Safe for Treatment of Defecation Disorders
 Botox Appears Safe for Treatment of Defecation Disorders 150 150 Kevin Mayhood
By: Kevin Mayhood

Anal botulinum toxin injections (Botox) have increasingly been used in children with functional anorectal and colonic disorders during the past 15 years. A study at Nationwide Children’s Hospital, combined with a review of published literature, shows this off-label use of Botox is safe and complications are rare. Complications occurred in less than 0.7% of 1332…

Type of Anorectal Malformation at Birth is Predictive of Fecal Continence
 Type of Anorectal Malformation at Birth is Predictive of Fecal Continence 150 150 Kevin Mayhood
By: Kevin Mayhood

Study also finds fecal continence rates for children born with ARMs are lower than previously reported. Recently published research shows the rate of fecal continence among 4-year-olds who underwent surgery for an anorectal malformation (ARM) as infants averages 40%, and the type of malformation — which reflects severity — is predictive of the outcome. Though…

Predicting Urinary Continence For a Child With Anorectal Malformation
 Predicting Urinary Continence For a Child With Anorectal Malformation 150 150 Kevin Mayhood
By: Kevin Mayhood

Researchers suggest objective, measurable factors can be used to provide families with reasonable expectations In a child born with an anorectal malformation (ARM), anatomical features including a low-complexity ARM, high sacral ratio and a normal spine each independently predicts the child has a higher chance of urinary continence, research at Nationwide Children’s Hospital shows. “When…

A New Therapeutic Era in Pediatric Functional and Motility Disorders
 A New Therapeutic Era in Pediatric Functional and Motility Disorders 150 150 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

20 years ago, treatment options were limited for children with functional gastrointestinal (GI) and motility disorders. Now, a growing list of drugs, behavioral and dietary care plans, and an advanced, forward-looking technique – neuromodulation – are transforming pediatric GI care. Gastrointestinal (GI) disorders are notoriously difficult to diagnose. Virtually all functional and motility-related GI problems…

Worth It: Why Wrestling Through the Logistical Challenges of a Multidisciplinary Colorectal Center Matters
 Worth It: Why Wrestling Through the Logistical Challenges of a Multidisciplinary Colorectal Center Matters 150 150 Jeb Phillips
By: Jeb Phillips

Consider the complex case of a girl born with rectal, vaginal and urinary tracts fused into a common channel – a cloacal malformation. The child needs reconstructive procedures across three different organ systems and three different surgical specialties. It could take months or years to manage the surgeries needed for the colorectal portion, then the…

A High Risk of Urological Diagnosis in Anorectal Malformations
 A High Risk of Urological Diagnosis in Anorectal Malformations 150 150 Jeb Phillips
By: Jeb Phillips

Opening the Door to Adult Medicine
 Opening the Door to Adult Medicine 1024 575 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES

Care transition plans aren’t just for kids with congenital conditions anymore. Could your practice benefit from a proactive transition plan for all patients? In the shift from pediatric to adult care, young patients have the responsibility to adjust to a new life of self-management. But health care providers also play an important role in this…

Saving Constipation Treatment Costs With a Bowel Management Program
 Saving Constipation Treatment Costs With a Bowel Management Program 1024 575 Jeb Phillips
By: Jeb Phillips
Simple illustrated diagram of the GI track with organs colorized and body outline and background in blue

A protocolized approach significantly reduced ED visits and hospital admissions for children with chronic constipation – and became a driver for surgical referrals. If hospitals are willing to foot the bill for staffing and start-up costs, a structured bowel management program for children with chronic severe constipation likely saves both individual and institutional health care…

In Sight: Three Procedures, One Surgery
 In Sight: Three Procedures, One Surgery 388 320 Jeb Phillips
By: Jeb Phillips

Colorectal Surgery, Urology and Gynecology coordinate to save tissue and time. A child with a complex colorectal and pelvic condition may require several surgeries over months or years before they are able to successfully manage their urine and stool. With advance planning and coordination it can be possible to treat many issues at once and…

InSight: Restoring Normal Habits
 InSight: Restoring Normal Habits 471 285 Tiasha Letostak, PhD
By: Tiasha Letostak, PhD

SACRAL NERVE STIMULATION (SNS) is a new treatment that helps control urinary incontinence and fecal soiling. For some children, the nerves that control urination and bowel movements do not work correctly. The SNS unit consists of a small, safe battery and wire under the skin and sends signals to the sacral nerve. The signals help restore…