Vesicointestinal Fissure

Sudipta Sen, V. Sripathi, and S. Suresh

Contents

14.1

Introduction . . . 239

14.2

Embryology of Cloacal Exstrophy .

. . 239

14.3

Nomenclature . . . 240

14.4

Antenatal Diagnosis . . . 240

14.5

Incidence ... 241

14.5.1

Genetics of Cloacal Exstrophy . . . 242

14.5.2

Risk Factors in the Development

of Cloacal Exstrophy . . . 242

14.5.3

Classification of Cloacal Exstrophy -

the

Manzoni Ransley Grid . . . 242

14.6

Anomalies Associated with Cloacal

Exstrophy . . . 242

14.6.1

The Skeletal System . . . 242

14.6.2

Renal Anomalies . . . 242

14.6.3

Genital Anomalies . . . 243

14.6.4

Central Nervous System Anomalies

. . . 243

14.6.5

The Gastrointestinal Tract . . . 243

14.6.6

Omphalocele . . . 243

14.6.7

The Pelvic Floor . . . 243

14.7

Management of Cloacal Exstrophy .

. . . 243

14.7.1

Survival and Quality of Life Issues .

. . 243

14.7.2

The Neonatal Operation . . . 243

14.7.2.1

The Standard Approach . . . 243

14.7.2.2

Variations in Neonatal Surgery . . .

244

14.7.3

Nutrition and Growth in Infancy

and Childhood . . . 244

14.7.4

Quality of Life Issues . . . 245

14.7.5

Anorectal Reconstruction and Fecal

Continence . . . 245

14.7.6

Urinary Reconstruction and Continence . . . 245

14.7.6.1

Bladder Turn-In . . . 245

14.7.6.2

Bladder Augmentation . . . 245

14.7.6.3

A Continent Catheterizable Port . .

. 245

14.7.7

Gender Assignment and Genital

Reconstruction . . . 246

14.7.8

Other Surgery and Ambulation . . .

246

14.7.9

Gynecologic management . . . 246

14.7.10

Psychosexual Problems . . . 246

14.7.11

The World Experience in the Management

of Cloacal Exstrophy . . . 246

References . . . 248

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