Other Surgery and Ambulation

Inguinal herniae are seen in 50% of cases. Upper urinary tract anomalies are common and may need correction [29,30]. Neurosurgical intervention includes surgery for tethered cord, meningomyelocele, and intraspinal lipoma [37]. In one report, 47 out of 50 cases underwent detethering of the cord [36]. Orthopedic intervention was required in 19 of 28 children, mainly to assist ambulation. Clubfoot, absent limbs, shortening of limbs, and scoliosis are some of the problems seen; 9 out of the 28 children were wheelchair bound [32].

Table 14.2 A summary of 11 published series in the management of cloacal exstrophy (1983-2001). CIC Clean intermittent catheterization, YDL Young-Dees-Leadbetter surgery, AUS artificial urinary sphincter

Authors [reference]

Total Number of cases (span)

Number survived

Tailgutostomy vs Ileostomy Bowel pull-through and results

1

Howell et al. 1983 [27]

15 (-)

13

9 tailgutostomy 4 ileostomy (2 converted to colostomy)

2

Diamond and Jeffs 1985 [38]

(22 years)

10

All 12 ileostomy (problems with short gut in 3)

3

Hurwitz et al.1987 [29]

(23 years)

12

Ileostomy has poorer outcome (Numbers not available)

6 pull-through, all incontinent

4

Stolar et al. 1990 [25]

(23 years)

10

2 tailgutostomy, 8 ileostomy (4 ileostomy converted to tailgutostomy)

5 pull-through, all reconverted to stomas (1 "natural" anus - continent)

5

Mitchell et al. 1990 [41]

16

10 tailgutostomy, 6 ileostomy (short gut problems with ileostomy)

7

Ricketts et al. 1991 [31]/Smith et al. 1997 [35]

12

11

4 tailgutostomy, 3 colostomy (variants), 4 ileostomy cases with dehydration, etc.

4 pull-through, continent with enemas

8

Mathews et al. 1998 [32]

37

24 ileostomy 13 tailgutostomy (tailgutostomy better)

5 pull-through, 2 reconverted to stomas

9

Husmann et al. 1999 [28]

(26 years)

23

?

?

10

Soffer et al. 2000 [26]

*

25

No ileostomy All tailgutostomy

25 pull-through, 3 continent, 4 occasional soiling, 11 with enemas

11

Lund and Hendren 2001 [36]

50

Colostomy preferred Number unavailable

25 pull-through, 19 clean with enemas, 4 reconverted to stomas

Male to

Urinary reconstruction

Points of interest

female gender

and success

conversion

in XY cases

6 of 9

12 incontinent stomas

Tailgutostomy preferable

to ileostomy

6 of 8

2 incontinent stomas

Report of urinary continence

8 bladder closure, of

(with CIC)

whom 3 continent

2 with CIC

4 of 16

3 incontinent stomas

Report gives survival

data over 1963-1986

4 of 6

4 incontinent stomas

Urinary continence with

5 continent with CIC

augments and CIC

(2 augmented bladder)

7 of 9

2 incontinent stoma

Gastric augment for blad

12 continent with CIC (12

der preferred

augmentation/reservoirs)

5 of 6

1 incontinent stoma

Continent reservoir with CIC

1 variant - voids

is best. Pull-through pos

8 continent with CIC

sible with enema program

(7 augmented bladders)

12 of 16

3 incontinent stomas

High rate of breakdown in initial

16 continent with CIC

bladder repair (14 of 31)

1 continent without CIC

(17 augmentation)

?

5 incontinent stomas

Poor results with YDL, AUS and

11 dry on CIC

collagen injection Results con

(13 augmented bladder)

trasted with classical exstrophy

5 of 6

1 continent without CIC

Avoids ileostomy Pro

12 dry with CIC (9

motes pull-through

augmentation)

22 of 28

28 dry with CIC

Urinary reservoir with Mitro-

3 dry without CIC

fanoff is the best option. Pull-

(35 augmentation)

through in selected cases only

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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