The Experts below are selected from a list of 204 Experts worldwide ranked by ideXlab platform
Lesley Breech - One of the best experts on this subject based on the ideXlab platform.
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gynecologic concerns in patients with Cloacal Anomaly
Seminars in Pediatric Surgery, 2016Co-Authors: Lesley BreechAbstract:Children with anorectal malformations (ARM) constitute a significant group within a pediatric surgery practice. It is important with female cases of anorectal malformations to consider the association of gynecologic anomalies, especially at the time of the definitive repair. However, it is critical to consider the association of such gynecologic anomalies when caring for patients with a Cloacal Anomaly. If not recognized, an opportunity to diagnose and treat such anomalies may be missed with the possibility of negative implications for future reproductive capacity. With the knowledge of the associated anomalies and long-term sequelae, surgeons can provide better care for girls and important counseling for parents. Knowledge of reproductive related issues in females with cloaca allows the pediatric surgeon an opportunity both, to provide optimal surgical management in infancy, childhood, and into young adulthood and to collaborate medically and surgically with an experienced gynecologist in patients with more complex anatomic variations. Appropriate counseling for patients and families about potential reproductive concerns that may develop many years after the definitive surgical repair allows preparation and planning to preserve future fertility.
M Natori - One of the best experts on this subject based on the ideXlab platform.
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prenatal diagnosis of fetal hydrometrocolpos secondary to a Cloacal Anomaly by magnetic resonance imaging
Ultrasound in Obstetrics & Gynecology, 2005Co-Authors: S Hayashi, H Sago, K Kashima, Yoshihiro Kitano, Tatsuo Kuroda, Toshiro Honna, S Nosaka, T Nakamura, M Kitagawa, M NatoriAbstract:Fetal female urogenital anomalies are often difficult to evaluate by ultrasonography, especially in late gestation. We report a case of fetal hydrometrocolpos detected at 35 weeks of gestation. Ultrasonography revealed a large retrovesical septate hypoechogenic mass in the fetal abdomen, however the sonographic findings were inconclusive. Magnetic resonance imaging (MRI) confirmed that the abdominal mass was fluid-filled with a mid-plane septum in the midline posterior to the bladder, and showed a connection to the dilated uterus that was duplicated. These findings were consistent with a diagnosis of hydrometrocolpos with septate vagina and uterus didelphys. The neonate showed abdominal distension, ambiguous genitalia and anal atresia with a single perineal opening. Hydrometrocolpos was secondary to a urethral type of Cloacal Anomaly. Aspiration of the mass and a colostomy were performed on the first postnatal day, followed by anorectoplasty at 19 months of age. MRI is a useful complementary tool for assessing fetal urogenital anomalies when ultrasonography is inconclusive. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.
Winston A Campbell - One of the best experts on this subject based on the ideXlab platform.
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late prenatal ultrasound features of hydrometrocolpos secondary to Cloacal Anomaly case reports and review of the literature
Ultrasound in Obstetrics & Gynecology, 1997Co-Authors: Anthony Odibo, Garry Turner, Adam Borgida, John F Rodis, Winston A CampbellAbstract:Cloacal anomalies are extremely rare and have variable presentations. Prenatal diagnosis can be difficult especially if they present in late gestation. Here we present two cases diagnosed in the late third trimester and review the literature regarding prenatal diagnosis of Cloacal anomalies. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
M H Moon - One of the best experts on this subject based on the ideXlab platform.
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p153 prenatal sonographic findings of Cloacal Anomaly
Ultrasound in Obstetrics & Gynecology, 2003Co-Authors: M J Song, B H Yi, M H MoonAbstract:Objective: To evaluate the sonographic characteristics of the Cloacal Anomaly on prenatal ultrasound and to correlate with pathologic findings. Methods: From March 1991 to December 2002, eight cases with the persistent cloaca (4 cases in female 1 case in male) and Cloacal exstrophy (3 cases) diagnosed by prenatal ultrasound examination were included, and all of them were pathologically confirmed by autopsy. One radiologist retrospectively analyzed the prenatal sonographic findings, including the urinary bladder, kidney, pelvic cyst, abdominal wall defect and amount of amniotic fluid. Results: The ultrasonographic diagnosis was established at 21.8 ± 7.8 weeks of gestation. The prenatal sonographic findings of the persistent cloaca were absent bladder (n = 2), distended bladder (n = 2), and small thick bladder (n = 1). Sonography of kidney showed normal (n = 2), hydronephrosis (n = 1), dysplasia (n = 1), and unilateral hydronephrosis with absent contralateral kidney (n = 1). Four fetuses showed septated pelvic cyst; three fetuses, oligohydramnios. The prenatal sonographic findings of Cloacal exstrophy included absent bladder (n = 3), normal kidney (n = 1), hydronephrosis (n = 1), and absent kidney (n = 1). All fetuses with Cloacal exstrophy had abdominal wall defect while two of them had ligohydramnios. Conclusions: A prenatal diagnosis of persistent cloaca can be confidently made when there is septated pelvic cyst combined oligohydramnios, sediments within the cyst and intraluminal calcifications. Cloacal exstrophy should be included in diagnosis if there is a low abdominal wall defect with absent urinary bladder.
Dan Wood - One of the best experts on this subject based on the ideXlab platform.
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augmentation vaginoplasty with buccal mucosa for the surgical revision of postreconstructive vaginal stenosis a case series
Journal of Pediatric Urology, 2019Co-Authors: H I Learner, Sarah M Creighton, Dan WoodAbstract:Summary Background Vaginal stenosis is a common consequence of vaginal reconstruction in childhood. Significant scarring can make dilation ineffective, and there maybe a paucity of skin to create perineal skin flaps. Numerous vaginoplasty techniques exist, including perineal skin flaps for distal stenosis and intestinal vaginoplasty requiring laparotomy and bowel anastomosis. Buccal mucosa graft is widely used in urethroplasty and has been reported in neovaginal construction. It is easily accessible with minimal graft site morbidity and provides a close functional replica to vaginal mucosa. Aim The aim was to describe the use of buccal mucosa grafts for the surgical revision of postreconstructive vaginal stenosis. Method The study setting was a tertiary centre for congenital gynaecological anomalies. Buccal mucosa grafting was provided to women with vaginal stenosis unsuitable for perineal skin flaps and in whom intestinal vaginoplasty was the next option. Four cases have been performed, and the medical notes were reviewed for clinical data. Results Mean age at buccal mucosa vaginoplasty was 21 years (range 18–26 years). Two patients had a Cloacal Anomaly, one had mosaic Turner syndrome and one had postradiation vaginal stenosis. All four had undergone previous vaginal reconstruction. In all cases, there was a tight band of vaginal stenosis either too proximal or with insufficient perineal tissue to allow a perineal flap vaginoplasty. There were no immediate complications. Mean clinic follow-up was 16 months (3 months–4 years). Two patients were able to have penetrative sexual intercourse, and two were using vaginal dilators successfully. Patients have an email contact for the team nurse specialist and therefore are able to contact before clinical review if they develop concerns. Discussion The use of buccal mucosal grafts for vaginoplasty is increasingly reported. This is the first detailed case series describing its use for augmentation vaginoplasty with postreconstructive/stenosis. Conclusions All patients had a successful outcome with a normal capacity vagina, and two were able to have penetrative intercourse. This suggests that buccal mucosal graft vaginoplasty is a safe and effective alternative for women with previous vaginal reconstruction requiring surgery for vaginal stenosis.
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adolescent and adult outcomes in women following childhood vaginal reconstruction for Cloacal Anomaly
The Journal of Urology, 2015Co-Authors: Ashani Couchman, Sarah M Creighton, Dan WoodAbstract:Purpose: We examined outcomes in female adolescents and women who underwent vaginoplasty in childhood during genitourinary reconstruction for Cloacal anomalies.Materials and Methods: We retrospectively reviewed the medical notes on girls and women attending an adult specialist center for genitourinary anomalies. Data were collected on vaginal reconstruction, menstruation, sexual and reproductive function, and urological and gastroenterological outcomes.Results: We identified 19 patients with a mean age of 22 years (range 13 to 35), of whom 16 (84%) underwent vaginoplasty in the first year of life. Nine of these 16 patients (56%) had required 1 (7) or 2 (2) further vaginal reconstructions to facilitate menstruation or sexual activity. The remaining 7 patients (44%) required no further vaginal reconstruction. Nine of the 19 patients (47%) had associated mullerian anomalies, obstructed menstruation developed in 5 (26%) and 1 required hemihysterectomy. Eight patients were sexually active, of whom 1 experience...
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Adolescent and adult outcomes in women following childhood vaginal reconstruction for Cloacal Anomaly.
The Journal of urology, 2015Co-Authors: Ashani Couchman, Sarah M Creighton, Dan WoodAbstract:We examined outcomes in female adolescents and women who underwent vaginoplasty in childhood during genitourinary reconstruction for Cloacal anomalies. We retrospectively reviewed the medical notes on girls and women attending an adult specialist center for genitourinary anomalies. Data were collected on vaginal reconstruction, menstruation, sexual and reproductive function, and urological and gastroenterological outcomes. We identified 19 patients with a mean age of 22 years (range 13 to 35), of whom 16 (84%) underwent vaginoplasty in the first year of life. Nine of these 16 patients (56%) had required 1 (7) or 2 (2) further vaginal reconstructions to facilitate menstruation or sexual activity. The remaining 7 patients (44%) required no further vaginal reconstruction. Nine of the 19 patients (47%) had associated müllerian anomalies, obstructed menstruation developed in 5 (26%) and 1 required hemihysterectomy. Eight patients were sexually active, of whom 1 experienced difficult penetration. Three patients attempted to conceive, including 1 with a complex preterm delivery and 2 undergoing fertility treatment. Of the patients 74% underwent further reconstruction of the renal tract and 36% had an enteric stoma. This study confirms the complexity of vaginal reconstruction in this group with a notable vaginoplasty revision rate. Müllerian anomalies were identified in almost half of the patients, a higher incidence than previously reported, and in a quarter obstructed menstruation developed in puberty. A specialist team with gynecologic input should treat patients with Cloacal anomalies. Outcome data are sparse. There remains a need for well planned, prospective cohort studies that include assessments of psychological, sexual and reproductive outcomes. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.