1
|
Yadav PS, Kapoor K, Khanna V, Pant N, Roy Choudhury S, Chadha R. Management of urinary incontinence in girls with congenital pouch colon. Pediatr Surg Int 2024; 40:168. [PMID: 38954013 DOI: 10.1007/s00383-024-05757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE This study describes the management of urinary incontinence (UI) in eight girls with congenital pouch colon (CPC) associated with anorectal malformation (ARM). METHODS From 2013 to 2015, six girls with CPC and UI underwent bladder neck reconstruction (BNR). Four girls had complete UI (CUI) and two girls partial UI (PUI). From 2019 to 2023, four girls, including two with failed BNR, underwent bladder neck closure (BNC) and augmentation cystoplasty (AC) with a continent stoma. Subtypes of CPC were Complete CPC (n = 7) and Incomplete CPC (n = 1). All girls had a double vagina; short, wide urethra; and reduced bladder capacity with an open, incompetent bladder neck (BNI). During BNR, a neourethra was constructed from a 1.5-2 cm-wide and 1.5-3-cm-long trigonal strip. During BNC, AC was performed using a 20 cm ileal segment (n = 3) and by a colonic pouch segment, preserved during earlier colorraphy (n = 1). Continent stoma included a Monti's channel (n = 3) and appendicovesicostomy (n = 1). RESULTS BNR produced moderate improvement of UI (n = 2), while UI was still very severe (n = 4). During BNC, intraoperative complications included iatrogenic vaginal tears (n = 4). Early complications included partial dehiscence of the ileocystoplasty (n = 1), partial adhesive small bowel obstruction (n = 1), and difficulty in stomal catheterization with prolonged drainage from the pelvic drain (n = 1). Late complications included unilateral grade II vesicoureteric reflux (n = 2) and vesicovaginal fistula (VVF) (n = 2) needing trans-vaginal closure in one girl. Urinary stones (n = 2) with stomal leakage of urine in one girl needed open cystolithotomy twice (n = 1), and endoscopic lithotripsy (n = 1). At follow-up, all patients have high overall satisfaction with the procedure and their continence status. CONCLUSIONS BNC with AC and a catheterizable stoma satisfactorily achieves continence in girls with CPC and UI, vastly improving quality of life. If lower urinary tract (LUT) anatomy is favorable, BNR with/without AC can be the initial surgical procedure. BNC should be the primary procedure in girls with unfavorable LUT anatomy and for failed BNR. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Partap Singh Yadav
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, 110001, India
| | - Kanu Kapoor
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, 110001, India
| | - Vikram Khanna
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, 110001, India
| | - Nitin Pant
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, 110001, India
| | - Subhasis Roy Choudhury
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, 110001, India
| | - Rajiv Chadha
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, 110001, India.
| |
Collapse
|
2
|
King AP, Donovan TA, Cohen E, Marin J, Le Roux AB. Short colon syndrome in cats. J Vet Intern Med 2024; 38:2138-2150. [PMID: 38757679 PMCID: PMC11256177 DOI: 10.1111/jvim.17103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/01/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Shortening of the colon has been described in cats, but its imaging and clinicopathological features remain poorly understood. OBJECTIVES Description of the signalment, clinical presentation, imaging, endoscopic and histological features of short colon syndrome in cats. ANIMALS Ninety-three cats diagnosed with short colon. METHODS Multi-institutional, descriptive, retrospective case series study. Medical records were searched for a diagnosis of short colon on abdominal ultrasonography, computed tomography, endoscopy, autopsy, or a combination of these modalities. RESULTS The median age of included cats was 12 years at the time of diagnosis. Diarrhea was the most common clinical sign (60/92; 65%), followed by vomiting (36/92; 39%), weight loss (36/92; 39%), and inappetence (24/92; 26%). Thirteen percent of cats (12/92) had no signs of gastrointestinal disease at the time of diagnosis. In addition to a shortened colonic length, 79% (66/84) of cats had concomitant colonic thickening on ultrasonographic examination. On colonoscopy, mucosal ulcerations of the colonic wall were seen in 39% (9/23) of cats. Histopathologically, all cats but 1 (diagnosed simultaneously with colonic small cell lymphoma) had lymphoplasmacytic colitis, and when small intestinal biopsies were performed, concurrent lymphoplasmacytic enteritis or small cell lymphoma of the small intestine. CONCLUSIONS AND CLINICAL IMPORTANCE Lymphoplasmacytic colitis is seen commonly in cats with short colon, suggesting a potential link between these entities.
Collapse
Affiliation(s)
- Audrey P. King
- Department of Diagnostic ImagingThe Schwarzman Animal Medical Center, 510 East 62nd StreetNew York, New York 10065USA
| | - Taryn A. Donovan
- Department of Anatomic PathologyThe Schwarzman Animal Medical Center, 510 East 62nd StreetNew York, New York 10065USA
| | - Eli Cohen
- Department of Molecular Biomedical SciencesNorth Carolina State College of Veterinary MedicineRaleigh, North Carolina 27607USA
- Dragonfly Imaging, PLLC, 1249 Kildaire Farm Road, #216Cary, North Carolina 27511USA
| | - Jenny Marin
- Department of Small Animal Clinical SciencesVA‐MD College of Veterinary Medicine, Virginia Tech, 205 Duck Pond DriveBlacksburg, Virginia 24061USA
| | - Alexandre B. Le Roux
- Department of Diagnostic ImagingThe Schwarzman Animal Medical Center, 510 East 62nd StreetNew York, New York 10065USA
- Present address:
Memorial Sloan Kettering Cancer Center, 417 East 68th StreetNew York, New York 10065USA
| |
Collapse
|
3
|
Bhusal A, Pokhrel S, Sah RP. Congenital pouch colon in a male neonate. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023] Open
|
4
|
Gupta A, Kumar A, Chadha R, Yadav P, Khanna V, Choudhury S. Congenital pouch colon in girls: An algorithm for preoperative diagnosis. J Indian Assoc Pediatr Surg 2022; 27:71-76. [PMID: 35261517 PMCID: PMC8853605 DOI: 10.4103/jiaps.jiaps_329_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/24/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: The aim of the study was o define the preoperative diagnostic clinical and radiological features in girls with congenital pouch colon (CPC). Materials and Methods: Records of 47 girls with CPC, managed from 1996 to 2018, were reviewed. There were two age groups: Group A (newborn to 12 months; n = 26) and Group B (>12 months to 20 years; n = 21). The important clinical and radiologic features to help in a preoperative diagnosis were noted. Results: The most common subtype was Type II (57.4%), followed by Type I (23.4%) and Type III (12.8%). The features common to both the groups were abdominal distension (A = 53.8%; B = 9.52%), severe perineal excoriation (A = 19.2%; B = 23/8%), and urinary incontinence (A = 30.7%; B = 85.7%). In addition, in Group B, fecaloma on abdominal palpation was noted in 28.6% of patients. The characteristic appearance of the perineum including external genitalia and findings on plain abdominal X-ray (AXR) were 100% accurate and hence diagnostic. These unique features helped us formulate an algorithm for preoperative diagnosis of this uncommon form of anorectal malformation in girls seen in North India. Conclusions: The characteristic features on clinical examination should alert one to the presence of CPC in the outpatient clinic. The AXR was diagnostic in 100% of cases and is mandatory. If any doubt persists, examination of the genitalia under anesthesia with more retraction of the labial folds and endoscopy can be performed for confirmation. These measures should enable a clinician to make an accurate preoperative diagnosis in every girl with CPC.
Collapse
|
5
|
Khan NA, Pant N, Gupta A, Anand R, Yadav PS, Chadha R, Choudhury SR. Radiologic Evaluation of Uterovaginal Abnormalities in Girls with Congenital Pouch Colon. J Indian Assoc Pediatr Surg 2019; 24:104-108. [PMID: 31105395 PMCID: PMC6417060 DOI: 10.4103/jiaps.jiaps_33_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background/Purpose: The radiologic investigations of 25 girls with congenital pouch colon (CPC), managed over 17 years, were retrospectively reviewed. In 13 girls who form the study group, the investigations provided information about the anomalous uterovaginal (UV) anatomy and these findings were studied. Materials and Methods: Age at presentation was 2 months to 10 years. The subtypes of CPC were Type I (n = 2), Type II (n = 9), and not recorded (n = 2). All patients had a double vagina and a unicornuate uterus on each side in the pelvis. The radiologic studies, performed at varying periods after surgery, included an intravenous urogram (IVU) (n = 4), micturating cystourethrogram (MCU) (n = 3), distal ileostogram/colostogram (n = 6), and magnetic resonance imaging (MRI) (n = 7). Results: IVU and MCU showed retrograde filling of the vaginas with contrast during micturition with a small-capacity urinary bladder and a relatively open bladder neck. The two vaginas were quite apart, but symmetrical in appearance and position. A distal dye study showed filling of the colonic pouch, its terminal fistula, and the two vaginas in six patients. Opacification of the bladder was seen in 3/6 girls, including one girl with left-sided Grade IV vesicoureteral reflux. MRI (n = 7) showed a monocornuate uterus on each side in the pelvis. The upper vaginas on each side were apart, being widely apart (n = 5) and somewhat closer (n = 2). The lower vaginas were closer with an intervaginal septum. Other findings were a widely open bladder neck and urethra in two girls with urinary incontinence and visualization of the terminal fistula of the colonic pouch (n = 2). The lumbosacral spine was normal in all patients. Conclusions: In girls with CPC, retrograde reflux of contrast into the vaginas during a distal dye study or an IVU/MCU may provide useful details of the anatomy of the vaginas. An MRI scan is recommended as essential for comprehensive evaluation of the anomalous UV anatomy.
Collapse
Affiliation(s)
- Niyaz Ahmed Khan
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Nitin Pant
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Amit Gupta
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Rama Anand
- Department of Radiology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Partap Singh Yadav
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Rajiv Chadha
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Subhasis Roy Choudhury
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| |
Collapse
|
6
|
Abstract
Congenital pouch colon (CPC) is an unusual abnormality in which a pouch-like dilatation of a shortened colon is associated with an anorectal malformation. It is categorized into four subtypes (Types I–IV) based on the length of normal colon proximal to the colonic pouch. In males, the pouch usually terminates in a colovesical fistula just proximal to the bladder neck. In girls, the terminal fistula opens either into the urethra or in the vestibule, close to the urethral opening. Girls usually have a double vagina with a wide inter-vaginal bridge, a monocornuate uterus on each side, and urinary incontinence due to a widely open bladder neck. Associated major malformations are uncommon with CPC but sometimes, especially in reports from outside India, major abnormalities are present suggesting an early, severe error in embryogenesis. The more severe Types I/II CPC can usually be diagnosed by a large gas shadow or air-fluid level on X-Ray abdomen. For all subtypes of CPC, it is preferable to preserve a segment of the pouch by fashioning a narrow colonic tube for pull-through, the technique known as coloplasty or tubular colorraphy. Girls need additional management of the genitourinary abnormalities. Postoperatively, fecal continence levels are usually poor, especially with Types I/II CPC.
Collapse
Affiliation(s)
- Rajiv Chadha
- Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| | - Niyaz Ahmed Khan
- Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| |
Collapse
|
7
|
Yilmaz O, Genc A, Ayhan S, Ozcan T, Aygoren R, Taneli1 C. A Female Patient with Congenital Pouch Colon (CPC): a Case Report. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2011.11680767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- O. Yilmaz
- Departments of Paediatric Surgery and Celal Bayar University, Medical Faculty, Manisa, Turkey
| | - A. Genc
- Departments of Paediatric Surgery and Celal Bayar University, Medical Faculty, Manisa, Turkey
| | - S. Ayhan
- Pathology, Celal Bayar University, Medical Faculty, Manisa, Turkey
| | - T. Ozcan
- Departments of Paediatric Surgery and Celal Bayar University, Medical Faculty, Manisa, Turkey
| | - R. Aygoren
- Departments of Paediatric Surgery and Celal Bayar University, Medical Faculty, Manisa, Turkey
| | - C. Taneli1
- Departments of Paediatric Surgery and Celal Bayar University, Medical Faculty, Manisa, Turkey
| |
Collapse
|
8
|
Chadha R, Khan NA, Shah S, Pant N, Gupta A, Choudhury SR, Debnath PR, Puri A. Congenital pouch colon in girls: Genitourinary abnormalities and their management. J Indian Assoc Pediatr Surg 2015; 20:105-15. [PMID: 26166979 PMCID: PMC4481620 DOI: 10.4103/0971-9261.159015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aims: To discuss the assessment and management of genitourinary (GU) tract abnormalities in 21 girls with Types I-III congenital pouch colon (CPC), studied over a period of 10 years. Materials and Methods: Assessment included clinical and radiological assessment, examination under anesthesia (EUA), endoscopy of the lower GU tract, and evaluation of the surgical findings, operative procedures for the GU anomalies, and the results of management. Results: Initial examination of the external genitalia showed a “clover-leaf” appearance (n = 6) and a single perineal opening (n = 6). In 9 patients, the openings of the urethra and double vagina were seen, of which a vestibular fistula was seen in 5 and an anterior perineal fistula in 1. Seventeen patients (81%) had urinary incontinence (UI) - partial in 10, and complete in 7. Renal function tests, X-ray sacrum, and abdominal US were normal in all patients. Micturating cystourethrogram (n = 9) showed a wide, bladder neck incompetence (BNI) with reduced bladder capacity in seven patients. EUA and endoscopy revealed a septate vagina in all patients and the urethral opening at a “high” position (n = 14) or at a relatively normal or “low” position (n = 7). In 8 patients, the intervaginal septum was thick and fleshy. Endoscopy showed a short, wide urethra, an open incompetent bladder neck, poorly developed trigone, and reduced bladder capacity in the patients with UI. The fistula from the colonic pouch opened in the proximal urethra (n = 4), high in the vestibule (n = 3), low in the vestibule (n = 8), perineum just posterior to the vestibule (n = 1), and undetermined (n = 5). Vaginoscopy (n = 8) showed normal cervices in all and cervical mucus in 4 patients. The subtypes of CPC were Type I CPC (n = 4), Type II CPC (n = 16), and Type III CPC (n = 1). All 21 patients had uterus didelphys. In four patients with UI, during tubular colorraphy, a segment of the colonic pouch was preserved for later bladder augmentation if required. A Young-Dees bladder-neck repair (BNR) was performed in four older girls for treatment of UI, with marked improvement in urinary continence in two girls, some improvement in one girl with complete urinary incontinence, and minimal improvement in one child. Division of the intervaginal septum was performed in three girls. Conclusions: GU abnormalities in girls with CPC need to be assessed and managed by a tailored protocol. UI is frequent, and its correction may require BNR. A segment of the colonic pouch can be preserved for possible future bladder augmentation. All girls have a septate vagina, often widely separated, and uterus didelphys. Gynecologic assessment and monitoring is required throughout adult life. Considering the wide opening of the vestibule, surgical management of the urogenital component by division of the intervaginal septum and if required, the vagino-fistula septum on each side results in a normal or a hypospadiac urethral opening and an adequate vaginal inlet.
Collapse
Affiliation(s)
- Rajiv Chadha
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Niyaz Ahmed Khan
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Shalu Shah
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Nitin Pant
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Amit Gupta
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Subhasis Roy Choudhury
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Pinaki Ranjan Debnath
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Archana Puri
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| |
Collapse
|
9
|
Kurian JJ, Bal HS, Sen S. Use of congenital pouch colon for augmenting the neurogenic bladder in a child: a 13-year follow-up. BMJ Case Rep 2015; 2015:bcr-2014-208486. [PMID: 25766441 DOI: 10.1136/bcr-2014-208486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Congenital pouch colon is an anomaly always associated with anorectal malformation, where the colon is replaced by or terminates into a large aperistaltic intestinal pouch. Vertebral anomalies leading to neurogenic bladder are rare associated malformations. The pouch is aperistaltic and thus a poor rectal substitute but this very property makes it ideal for bladder augmentation. We report the first case where the pouch has been used to augment a high-pressure neurogenic bladder.
Collapse
Affiliation(s)
- Jujju Jacob Kurian
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamilnadu, India
| | - Harshjeet Singh Bal
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamilnadu, India
| | - Sudipta Sen
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamilnadu, India
| |
Collapse
|
10
|
Chadha R, Puri M, Saxena R, Agarwala S, Puri A, Choudhury SR. Congenital pouch colon in a girl associated with bilateral atresia of cervix uteri and uterus didelphys. J Indian Assoc Pediatr Surg 2013; 18:81-3. [PMID: 23798813 PMCID: PMC3687153 DOI: 10.4103/0971-9261.109360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This report describes a girl with congenital pouch colon (CPC), uterus didelphys with septate vagina, and a cloacal anomaly. The girl underwent cloacal reconstruction at the age of 15 months. Subsequently, at puberty, the child had primary amenorrhea with severe cyclic abdominal pain due to endometriosis of both the uteruses and adnexal cysts with hematometra and hematosalpinx. Laparotomy with removal of both uteri and the left fallopian tube was performed. Both uteri had atresia of the cervix uteri. This report emphasizes the need for comprehensive evaluation and a long-term management strategy for associated gynecologic anomalies in girls with CPC, especially with regard to patency of the outflow tract.
Collapse
Affiliation(s)
- Rajiv Chadha
- Department of Pediatric Surgery, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | | | | | | | | | | |
Collapse
|
11
|
The anomalous clinical anatomy of congenital pouch colon in girls. J Pediatr Surg 2011; 46:1593-602. [PMID: 21843729 DOI: 10.1016/j.jpedsurg.2011.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 12/11/2010] [Accepted: 01/12/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study was to evaluate the anomalous clinical anatomy of congenital pouch colon (CPC) associated with anorectal agenesis in 22 consecutive girls managed over a study period of 7 years. METHODS The 22 patients were categorized into 2 groups. Group A consisted of 10 patients who presented during the neonatal period (n = 9) or as a young infant (n = 1). In these patients, only preliminary assessment results were available. Group B (12 patients) comprised 5 newborns who remained on follow-up and 7 patients who presented after the age of 1 year. These 12 patients were assessed and investigated in more detail. RESULTS In group A patients, apart from absence of the normal anal opening, the appearance of the external genitalia and perineum was essentially normal. Retraction of the labial folds showed radiation of folds inward from the margins of the vulval vestibule toward the center, at a point of confluence located at a higher level. At laparotomy, the subtypes of CPC were type I (n = 4), type II (n = 5), and type III (n = 1). In 8 patients, uterus didelphys was present. In all group B patients, the appearance of the external genitalia was similar to that in group A patients. However, separate openings of the urethra, septate vagina, and vestibular fistula (if present) were visible in 5 patients, whereas in 3 patients, a single perineal opening was identified. A total of 9/12 patients (75%) had urinary incontinence. Examination under anesthesia and endoscopy revealed a septate vagina in all 12 patients and an open, incompetent bladder neck with reduced bladder capacity in the 9 patients with urinary incontinence. The terminal fistula of the colonic pouch opened just distal to the bladder neck (n = 1), just posterior and cephalad to the urethral opening (n = 2), low in the vestibule (n = 5), and undetermined (n = 4). The subtypes of CPC were type I CPC (n = 2), type II CPC (n = 9), and type III CPC (n = 1). All 12 patients had uterus didelphys. CONCLUSIONS The characteristics in the anomalous clinical anatomy of CPC in girls, as described here, appear to be almost invariable and, especially in regions where CPC is common, should alert the clinician to the presence of this malformation.
Collapse
|