The lateral view is the best view for measuring your sacral index. There is less alteration. On the AP view, it always tends to be a little bit smaller than it does on the lateral view.
Perforation during colostography with hyperosmotic contrast (e.g., cystoconray, ~400 mOsm) causes immediate fluid shift and peritonitis requiring emergent IV fluids and surgical consultation.
Cystoscopy by an experienced urologist can identify the fistula in approximately 9 out of 10 cases, though prior surgical experience found only 3 out of 10 fistulas visible cystoscopically
clinicalIn females, prenatal ultrasound showing bilateral hydronephrosis, small bladder, and dilated vagina suggests cloaca.↗
▶Ep 25 · 4:40
quoteThe combination of those three components in a female should make you begin to at least consider the diagnosis of cloacal malformation.↗
▶Ep 25 · 7:14
clinicalCalcified enteroliths in the GI tract on neonatal KUB indicate urine mixing with meconium, suggesting a recto-GU fistula at least at the bulbar level or higher.↗
▶Ep 25 · 8:00
quoteSo you know that there is urine mixing with meconium, and that tends to calcify fairly quickly. So this patient has a rectal GU connection.↗
▶Ep 25 · 10:08
clinicalAfter 20 to 24 weeks gestation, T1 hyperintensity of meconium within the colon should be visible on fetal MRI; loss of T1 hyperintensity and bright T2 signal suggests urine mixing.↗
▶Ep 25 · 10:08
clinicalOn fetal MRI, the distal rectum should extend at least 10 mm below the bladder neck in the second trimester, up to 20–24 mm in the third trimester; high position suggests ARM.↗
▶Ep 25 · 14:10
quoteWhen you see a hemisacrum, you have to start thinking about curavenous triad. And you have to presume that there is a presacral mass there.↗
▶Ep 25 · 15:35
clinicalWhen hemisacrum is seen in a patient with anal malformation, Currarino triad must be assumed and presacral mass must be looked for.↗
▶Ep 25 · 17:00
clinicalFor sacral ratio measurement, a true AP pelvis (not angled sacral view) and lateral pelvis are required; the lateral view is more accurate.↗
▶Ep 25 · 17:00
quoteThe lateral view is the best view for measuring your sacral index. There is less alteration. On the AP view, it always tends to be a little bit smaller than it does on the lateral view.↗
▶Ep 25 · 21:48
clinicalNormal sacral ratio ranges from 0.6 to 1.0; below 0.3 predicts very low likelihood of continence.↗
▶Ep 25 · 23:00
quoteIf you're particularly under 0.3, the likelihood of continence is very low.↗
▶Ep 25 · 36:40
clinicalCross-table lateral (invertogram) must be performed after 24 to 36 hours to allow enough air and pressure to show the true level of the distal rectal pouch.↗
▶Ep 25 · 38:00
quoteYou really can't do this and get an accurate knowledge or an accurate representation of where that distal rectum really is unless you do this after 24 to 36 hours.↗
▶Ep 25 · 55:00
clinicalIt is difficult to distinguish radiologically between prostatic and bulbar urethral fistulae; the bend in the urethra is used as an approximate landmark.↗
▶Ep 25 · 56:20
quoteThe key is making sure that you have very good pressure and you have a good length of colon there for the surgeons.↗
▶Ep 25 · 56:56
clinicalDistal colonic segments that are very dilated and atonic are at higher risk of perforation during colostography due to Laplace's law (thin wall, high pressure).↗
▶Ep 25 · 58:21
clinicalPerforation during colostography with hyperosmotic contrast (e.g., cystoconray, ~400 mOsm) causes immediate fluid shift and peritonitis requiring emergent IV fluids and surgical consultation.↗
▶Ep 25 · 59:58
clinicalIso-osmotic contrast is now preferred for distal colostography to avoid fluid shifts if perforation occurs.↗
▶Ep 25 · 1:00:20
quoteThe problem is the contrast agent we use now where we are is a isosmotic contrast. As a result of that, we changed. And we use a contrast agent that's very dense, but it's isosmotic to body fluids. So if it were to get into the perineum, there would not be any fluid shifts.↗
ARMs in Male Patients: Pediatric Colorectal Controversies 2014
▶Ep 30 · 28:31
clinicalCombining distal colostography with VCUG in the same setting provides complete anatomical information; the colostogram is done first, contrast removed, then VCUG performed↗
▶Ep 30 · 28:50
clinicalDistal colostography requires both lateral and oblique/AP views with full distention and exact measurements to adequately assess fistula location and rectal length↗
▶Ep 30 · 36:37
clinicalBladder-neck fistulas are distinguished from prostatic fistulas by location above the angle of the urethra; prostatic fistulas are at or below the urethral angle↗
▶Ep 30 · 38:00
clinicalCystoscopy by an experienced urologist can identify the fistula in approximately 9 out of 10 cases, though prior surgical experience found only 3 out of 10 fistulas visible cystoscopically↗
clinicalIn females, prenatal ultrasound showing bilateral hydronephrosis, small bladder, and dilated vagina suggests cloaca.↗
▶Ep 16 · 4:40
quoteThe combination of those three components in a female should make you begin to at least consider the diagnosis of cloacal malformation.↗
▶Ep 16 · 7:14
clinicalCalcified enteroliths in the GI tract on neonatal KUB indicate urine mixing with meconium, suggesting a recto-GU fistula at least at the bulbar level or higher.↗
▶Ep 16 · 8:00
quoteSo you know that there is urine mixing with meconium, and that tends to calcify fairly quickly. So this patient has a rectal GU connection.↗
▶Ep 16 · 10:08
clinicalOn fetal MRI, the distal rectum should extend at least 10 mm below the bladder neck in the second trimester, up to 20–24 mm in the third trimester; high position suggests ARM.↗
▶Ep 16 · 10:08
clinicalAfter 20 to 24 weeks gestation, T1 hyperintensity of meconium within the colon should be visible on fetal MRI; loss of T1 hyperintensity and bright T2 signal suggests urine mixing.↗
▶Ep 16 · 14:10
quoteWhen you see a hemisacrum, you have to start thinking about curavenous triad. And you have to presume that there is a presacral mass there.↗
▶Ep 16 · 15:35
clinicalWhen hemisacrum is seen in a patient with anal malformation, Currarino triad must be assumed and presacral mass must be looked for.↗
▶Ep 16 · 17:00
quoteThe lateral view is the best view for measuring your sacral index. There is less alteration. On the AP view, it always tends to be a little bit smaller than it does on the lateral view.↗
▶Ep 16 · 17:00
clinicalFor sacral ratio measurement, a true AP pelvis (not angled sacral view) and lateral pelvis are required; the lateral view is more accurate.↗
▶Ep 16 · 21:48
clinicalNormal sacral ratio ranges from 0.6 to 1.0; below 0.3 predicts very low likelihood of continence.↗
▶Ep 16 · 23:00
quoteIf you're particularly under 0.3, the likelihood of continence is very low.↗
▶Ep 16 · 36:40
clinicalCross-table lateral (invertogram) must be performed after 24 to 36 hours to allow enough air and pressure to show the true level of the distal rectal pouch.↗
▶Ep 16 · 38:00
quoteYou really can't do this and get an accurate knowledge or an accurate representation of where that distal rectum really is unless you do this after 24 to 36 hours.↗
▶Ep 16 · 55:00
clinicalIt is difficult to distinguish radiologically between prostatic and bulbar urethral fistulae; the bend in the urethra is used as an approximate landmark.↗
▶Ep 16 · 56:20
quoteThe key is making sure that you have very good pressure and you have a good length of colon there for the surgeons.↗
▶Ep 16 · 56:56
clinicalDistal colonic segments that are very dilated and atonic are at higher risk of perforation during colostography due to Laplace's law (thin wall, high pressure).↗
▶Ep 16 · 58:21
clinicalPerforation during colostography with hyperosmotic contrast (e.g., cystoconray, ~400 mOsm) causes immediate fluid shift and peritonitis requiring emergent IV fluids and surgical consultation.↗
▶Ep 16 · 59:58
clinicalIso-osmotic contrast is now preferred for distal colostography to avoid fluid shifts if perforation occurs.↗
▶Ep 16 · 1:00:20
quoteThe problem is the contrast agent we use now where we are is a isosmotic contrast. As a result of that, we changed. And we use a contrast agent that's very dense, but it's isosmotic to body fluids. So if it were to get into the perineum, there would not be any fluid shifts.↗
Greg's statements about Colorectal / ARM & Hirschsprung48 statements
clinicalIn females, prenatal ultrasound showing bilateral hydronephrosis, small bladder, and dilated vagina suggests cloaca.↗
▶Ep 59 · 2:12
clinicalIn females, prenatal ultrasound showing bilateral hydronephrosis, small bladder, and dilated vagina suggests cloaca.↗
▶Ep 59 · 4:40
quoteThe combination of those three components in a female should make you begin to at least consider the diagnosis of cloacal malformation.↗
▶Ep 59 · 4:40
quoteThe combination of those three components in a female should make you begin to at least consider the diagnosis of cloacal malformation.↗
▶Ep 59 · 7:14
clinicalCalcified enteroliths in the GI tract on neonatal KUB indicate urine mixing with meconium, suggesting a recto-GU fistula at least at the bulbar level or higher.↗
▶Ep 59 · 7:14
clinicalCalcified enteroliths in the GI tract on neonatal KUB indicate urine mixing with meconium, suggesting a recto-GU fistula at least at the bulbar level or higher.↗
▶Ep 59 · 8:00
quoteSo you know that there is urine mixing with meconium, and that tends to calcify fairly quickly. So this patient has a rectal GU connection.↗
▶Ep 59 · 8:00
quoteSo you know that there is urine mixing with meconium, and that tends to calcify fairly quickly. So this patient has a rectal GU connection.↗
▶Ep 59 · 10:08
clinicalAfter 20 to 24 weeks gestation, T1 hyperintensity of meconium within the colon should be visible on fetal MRI; loss of T1 hyperintensity and bright T2 signal suggests urine mixing.↗
▶Ep 59 · 10:08
clinicalOn fetal MRI, the distal rectum should extend at least 10 mm below the bladder neck in the second trimester, up to 20–24 mm in the third trimester; high position suggests ARM.↗
▶Ep 59 · 10:08
clinicalAfter 20 to 24 weeks gestation, T1 hyperintensity of meconium within the colon should be visible on fetal MRI; loss of T1 hyperintensity and bright T2 signal suggests urine mixing.↗
▶Ep 59 · 10:08
clinicalOn fetal MRI, the distal rectum should extend at least 10 mm below the bladder neck in the second trimester, up to 20–24 mm in the third trimester; high position suggests ARM.↗
▶Ep 59 · 14:10
quoteWhen you see a hemisacrum, you have to start thinking about curavenous triad. And you have to presume that there is a presacral mass there.↗
▶Ep 59 · 14:10
quoteWhen you see a hemisacrum, you have to start thinking about curavenous triad. And you have to presume that there is a presacral mass there.↗
▶Ep 59 · 15:35
clinicalWhen hemisacrum is seen in a patient with anal malformation, Currarino triad must be assumed and presacral mass must be looked for.↗
▶Ep 59 · 15:35
clinicalWhen hemisacrum is seen in a patient with anal malformation, Currarino triad must be assumed and presacral mass must be looked for.↗
▶Ep 59 · 17:00
clinicalFor sacral ratio measurement, a true AP pelvis (not angled sacral view) and lateral pelvis are required; the lateral view is more accurate.↗
▶Ep 59 · 17:00
quoteThe lateral view is the best view for measuring your sacral index. There is less alteration. On the AP view, it always tends to be a little bit smaller than it does on the lateral view.↗
▶Ep 59 · 17:00
clinicalFor sacral ratio measurement, a true AP pelvis (not angled sacral view) and lateral pelvis are required; the lateral view is more accurate.↗
▶Ep 59 · 17:00
quoteThe lateral view is the best view for measuring your sacral index. There is less alteration. On the AP view, it always tends to be a little bit smaller than it does on the lateral view.↗
▶Ep 59 · 21:48
clinicalNormal sacral ratio ranges from 0.6 to 1.0; below 0.3 predicts very low likelihood of continence.↗
▶Ep 59 · 21:48
clinicalNormal sacral ratio ranges from 0.6 to 1.0; below 0.3 predicts very low likelihood of continence.↗
▶Ep 59 · 23:00
quoteIf you're particularly under 0.3, the likelihood of continence is very low.↗
▶Ep 59 · 23:00
quoteIf you're particularly under 0.3, the likelihood of continence is very low.↗
▶Ep 59 · 36:40
clinicalCross-table lateral (invertogram) must be performed after 24 to 36 hours to allow enough air and pressure to show the true level of the distal rectal pouch.↗
▶Ep 59 · 36:40
clinicalCross-table lateral (invertogram) must be performed after 24 to 36 hours to allow enough air and pressure to show the true level of the distal rectal pouch.↗
▶Ep 59 · 38:00
quoteYou really can't do this and get an accurate knowledge or an accurate representation of where that distal rectum really is unless you do this after 24 to 36 hours.↗
▶Ep 59 · 38:00
quoteYou really can't do this and get an accurate knowledge or an accurate representation of where that distal rectum really is unless you do this after 24 to 36 hours.↗
▶Ep 59 · 55:00
clinicalIt is difficult to distinguish radiologically between prostatic and bulbar urethral fistulae; the bend in the urethra is used as an approximate landmark.↗
▶Ep 59 · 55:00
clinicalIt is difficult to distinguish radiologically between prostatic and bulbar urethral fistulae; the bend in the urethra is used as an approximate landmark.↗
▶Ep 59 · 56:20
quoteThe key is making sure that you have very good pressure and you have a good length of colon there for the surgeons.↗
▶Ep 59 · 56:20
quoteThe key is making sure that you have very good pressure and you have a good length of colon there for the surgeons.↗
▶Ep 59 · 56:56
clinicalDistal colonic segments that are very dilated and atonic are at higher risk of perforation during colostography due to Laplace's law (thin wall, high pressure).↗
▶Ep 59 · 56:56
clinicalDistal colonic segments that are very dilated and atonic are at higher risk of perforation during colostography due to Laplace's law (thin wall, high pressure).↗
▶Ep 59 · 58:21
clinicalPerforation during colostography with hyperosmotic contrast (e.g., cystoconray, ~400 mOsm) causes immediate fluid shift and peritonitis requiring emergent IV fluids and surgical consultation.↗
▶Ep 59 · 58:21
clinicalPerforation during colostography with hyperosmotic contrast (e.g., cystoconray, ~400 mOsm) causes immediate fluid shift and peritonitis requiring emergent IV fluids and surgical consultation.↗
▶Ep 59 · 59:58
clinicalIso-osmotic contrast is now preferred for distal colostography to avoid fluid shifts if perforation occurs.↗
▶Ep 59 · 59:58
clinicalIso-osmotic contrast is now preferred for distal colostography to avoid fluid shifts if perforation occurs.↗
▶Ep 59 · 1:00:20
quoteThe problem is the contrast agent we use now where we are is a isosmotic contrast. As a result of that, we changed. And we use a contrast agent that's very dense, but it's isosmotic to body fluids. So if it were to get into the perineum, there would not be any fluid shifts.↗
▶Ep 59 · 1:00:20
quoteThe problem is the contrast agent we use now where we are is a isosmotic contrast. As a result of that, we changed. And we use a contrast agent that's very dense, but it's isosmotic to body fluids. So if it were to get into the perineum, there would not be any fluid shifts.↗
ARMs in Male Patients: Pediatric Colorectal Controversies 2014
▶Ep 66 · 28:31
clinicalCombining distal colostography with VCUG in the same setting provides complete anatomical information; the colostogram is done first, contrast removed, then VCUG performed↗
▶Ep 66 · 28:31
clinicalCombining distal colostography with VCUG in the same setting provides complete anatomical information; the colostogram is done first, contrast removed, then VCUG performed↗
▶Ep 66 · 28:50
clinicalDistal colostography requires both lateral and oblique/AP views with full distention and exact measurements to adequately assess fistula location and rectal length↗
▶Ep 66 · 28:50
clinicalDistal colostography requires both lateral and oblique/AP views with full distention and exact measurements to adequately assess fistula location and rectal length↗
▶Ep 66 · 36:37
clinicalBladder-neck fistulas are distinguished from prostatic fistulas by location above the angle of the urethra; prostatic fistulas are at or below the urethral angle↗
▶Ep 66 · 36:37
clinicalBladder-neck fistulas are distinguished from prostatic fistulas by location above the angle of the urethra; prostatic fistulas are at or below the urethral angle↗
▶Ep 66 · 38:00
clinicalCystoscopy by an experienced urologist can identify the fistula in approximately 9 out of 10 cases, though prior surgical experience found only 3 out of 10 fistulas visible cystoscopically↗
▶Ep 66 · 38:00
clinicalCystoscopy by an experienced urologist can identify the fistula in approximately 9 out of 10 cases, though prior surgical experience found only 3 out of 10 fistulas visible cystoscopically↗
Greg's statements about Hirschsprung disease4 statements
ARMs in Male Patients: Pediatric Colorectal Controversies 2014
▶Ep 27 · 28:31
clinicalCombining distal colostography with VCUG in the same setting provides complete anatomical information; the colostogram is done first, contrast removed, then VCUG performed↗
▶Ep 27 · 28:50
clinicalDistal colostography requires both lateral and oblique/AP views with full distention and exact measurements to adequately assess fistula location and rectal length↗
▶Ep 27 · 36:37
clinicalBladder-neck fistulas are distinguished from prostatic fistulas by location above the angle of the urethra; prostatic fistulas are at or below the urethral angle↗
▶Ep 27 · 38:00
clinicalCystoscopy by an experienced urologist can identify the fistula in approximately 9 out of 10 cases, though prior surgical experience found only 3 out of 10 fistulas visible cystoscopically↗
Greg's statements about Rectourethral Fistula8 statements
ARMs in Male Patients: Pediatric Colorectal Controversies 2014
▶Ep 4 · 28:31
clinicalCombining distal colostography with VCUG in the same setting provides complete anatomical information; the colostogram is done first, contrast removed, then VCUG performed↗
▶Ep 4 · 28:31
clinicalCombining distal colostography with VCUG in the same setting provides complete anatomical information; the colostogram is done first, contrast removed, then VCUG performed↗
▶Ep 4 · 28:50
clinicalDistal colostography requires both lateral and oblique/AP views with full distention and exact measurements to adequately assess fistula location and rectal length↗
▶Ep 4 · 28:50
clinicalDistal colostography requires both lateral and oblique/AP views with full distention and exact measurements to adequately assess fistula location and rectal length↗
▶Ep 4 · 36:37
clinicalBladder-neck fistulas are distinguished from prostatic fistulas by location above the angle of the urethra; prostatic fistulas are at or below the urethral angle↗
▶Ep 4 · 36:37
clinicalBladder-neck fistulas are distinguished from prostatic fistulas by location above the angle of the urethra; prostatic fistulas are at or below the urethral angle↗
▶Ep 4 · 38:00
clinicalCystoscopy by an experienced urologist can identify the fistula in approximately 9 out of 10 cases, though prior surgical experience found only 3 out of 10 fistulas visible cystoscopically↗
▶Ep 4 · 38:00
clinicalCystoscopy by an experienced urologist can identify the fistula in approximately 9 out of 10 cases, though prior surgical experience found only 3 out of 10 fistulas visible cystoscopically↗
