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

Getting Back Into Shape After The Pregnancy

Getting Back Into Shape After The Pregnancy

Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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