Andrea Badillo - Academia.edu (original) (raw)
Papers by Andrea Badillo
Journal of Pediatric Surgery
Journal of Surgical Research, Feb 1, 2007
Seminars in Pediatric Surgery, Dec 1, 2020
Lasting impact on children with an anorectal malformations with proper surgical preparation, resp... more Lasting impact on children with an anorectal malformations with proper surgical preparation, respect for anatomic principles, and precise surgical management,
Journal of Pediatric Surgery, Mar 1, 2023
Blood, Nov 16, 2005
Murine mesenchymal stem cells (mMSC) are capable of differentiation into multiple cell types in v... more Murine mesenchymal stem cells (mMSC) are capable of differentiation into multiple cell types in vitro, and as a result have been proposed as ideal candidates for the development of cellular based therapy for tissue repair. The distribution, engraftment, and differentiation properties of these cells in vivo have yet to be conclusively defined. Reports of mMSC engraftment and differentiation are confounded by issues of cell population purity, questions of fusion, a reliance on pathologic injury models to demonstrate significant engraftment levels, and immunofluorescent based cell tracking modalities which are prone to artifact and rely on subjective interpretation. In this study, we utilize a non-injured neonatal mouse model to demonstrate the fate of culture expanded, purified mMSC derived from the bone marrow of adult GFP transgenic mice. Following intravascular injection into Swiss Webster neonatal mice on the first day of life, mMSC were tracked with fluorescent stereomicroscopy and corresponding tissue specimens were collected and processed for histology and immunoperoxidase staining for GFP. mMSC were found to concentrate within the lungs with few, isolated cells visualized outside the lungs. Histological examination confirmed the presence of GFP expressing cells within the pulmonary vasculature but occurring as aggregates of bone. These nodules were found as early as 9 days after injection and persisted to 42 days after injection. These nodules were located within the confines of the vessel wall and were surrounded by an inflammatory infiltrate. There was no evidence of tissue invasion nor did these cells demonstrate malignant features. These bony aggregrates were also demonstrated after injection into C57Bl/6 congenic controls. Our findings indicate that mMSC are filtered by the pulmonary vasculature following intravenous injection thereby limiting their capacity to reach other tissues. The large adherent phenotype of these cells makes them prone to vessel lodgment, and this lodgment results is aberrant osteogenesis. These findings have major implications for intravascular stem cell based therapies for tissue repair.
Journal of Investigative Dermatology, Jul 1, 2008
Adult wound healing is characterized by an exuberant inflammatory response and scar formation. In... more Adult wound healing is characterized by an exuberant inflammatory response and scar formation. In contrast, scarless fetal wound healing has diminished inflammation, a lack of fibroplasia, and restoration of normal architecture. We have previously shown that fetal wounds produce less inflammatory cytokines, and the absence of IL-10, an anti-inflammatory cytokine, results in fetal scar formation. We hypothesized that increased IL-10 would decrease inflammation and create an environment conducive for regenerative healing in the adult. To test this hypothesis, a lentiviral vector expressing IL-10 and green fluorescent protein (GFP) (Lenti-IL-10) or GFP alone (Lenti-GFP) was injected at the wound site 48 hours before wounding. We found that both Lenti-IL-10 and Lenti-GFP were expressed in the wounds at 1 and 3 days post wounding. At 3 days, Lenti-IL-10-treated wounds demonstrated decreased inflammation and decreased quantities of all proinflammatory mediators analyzed with statistically different levels of IL-6, monocyte chemoattractant protein-1, and heat-shock protein 47. At 3 weeks, Lenti-GFP wounds demonstrated scar formation. In contrast, wounds injected with Lenti-IL-10 demonstrated decreased inflammation, a lack of abnormal collagen deposition, and restoration of normal dermal architecture. We conclude that lentivirus-mediated overexpression of IL-10 decreases the inflammatory response to injury, creating an environment conducive for regenerative adult wound healing.
Journal of Pediatric Surgery, Feb 1, 2023
European Journal of Pediatric Surgery Reports, 2022
Blood, Nov 16, 2005
Mesenchymal stem cells (MSCs) are multipotent cells of potential clinical interest given their ca... more Mesenchymal stem cells (MSCs) are multipotent cells of potential clinical interest given their capacity for in vitro expansion and intriguing immunologic properties. Studies using human and murine MSCs demonstrated their ability to suppress stimulated T cells in vitro. Consequently, much interest has been generated in the ability of MSCs to prevent graft versus host disease (GVHD). In fact, a limited number of case reports suggest a therapeutic role of human MSCs in the treatment of GVHD. Although encouraging, no systematic study has been performed to assess the ability of MSCs to suppress GVHD in vivo. In the current study we utilize a purified population of adult bone marrow derived murine MSCs previously shown to be immunosuppressive in vitro to evaluate the therapeutic potential in vivo of MSCs in an established model of murine GVHD. Methods: 8–12 week old C57Bl/6xBalb/c F1 mice were given 750cGy irradiation in a Cs135 gamma irradiator. 16–20 hours after irradiation, the mice received one of four groups of donor cells via lateral tail vein injection: 1) 10e6 C57Bl/6 (B6) bone marrow cells (BM) (n=5), 2) 10e6 B6 BM cells + 30e6 B6 spleen cells (n=12) (GVHD inoculum), 3) 10e6 B6 BM cells + 30e6 B6 spleen cells + 1e6 B6 MSCs (n=4) or 4) 10e6 B6 BM cells + 30e6 B6 spleen cells + 1.5e5 B6 MSCs (n=7). Mice were weighed and assessed for physical signs of GVHD such as ruffled fur, desquamation, diarrhea and hunching prior to receiving irradiation and on a weekly basis following irradiation and injection of the cellular inoculum. Results: In accordance with previous studies, the injection of 30e6 parental (B6) spleen cells combined with 10e6 (B6) parental BM cells into an F1 (B6xBalb/c) recipient following 750cGy irradiation resulted in a reliable model of GVHD. All mice receiving this inoculum demonstrated physical signs of GVHD including hunching and ruffled fur by three weeks post injection with the progression to desquamation and diarrhea by 5 weeks post injection. Similar to mice receiving the GVHD inoculum, mice receiving 30e6 B6 spleen cells + 10e6 B6 BM cells + either 1e6 B6 MSCs or 1.5e5 B6 MSCs demonstrated physical signs of GVHD by 3 weeks post injection. Control mice receiving only 10e6 B6 BM cells after 750cGy irradiation remained healthy and did not demonstrate any signs of GVHD. As demonstrated in figure 1, coinjection of either 1e6 B6 MSCs or 1.5e5 B6 MSCs with 30e6 B6 spleen cells + 10e6 B6 BM cells did not result in any significant change in weight loss compared to those mice receiving the GVHD inoculum. Similarly, the survival of mice receiving the GVHD inoculum was not improved by the coinjection of either 1e6 B6 MSCs or 1.5e5 B6 MSCs (25% vs 0% vs 28.57% at 6 weeks post injection). Conclusion: Previous studies have supported an in vitro immunosuppressive function of MSCs and a limited number of human studies have highlighted the potential ability of human MSCs to suppress GVHD. Despite these previous findings the current study demonstrates that the intravenous injection of MHC matched murine MSCs at the time of GVHD induction in an established murine model of GVHD does not affect the onset or severity of GVHD as measured by physical exam, weight loss and survival. Figure Figure
European Journal of Pediatric Surgery
Journal of Pediatric Surgery, 2019
Background: Pediatric surgery (PS) is among the most competitive fellowship opportunities for gen... more Background: Pediatric surgery (PS) is among the most competitive fellowship opportunities for general surgery residents. Prior investigations into factors associated with successful matriculation to PS have relied on surveys, which have inherent biases. Study design: Data were extracted from the Electronic Residency Application System for applicants from 2012 to 2017 and analyzed after stratification by matriculation status. Results: Data were gathered on a total of 444 applicants, of which 238 matriculated. The applicant pool was predominantly Caucasian (63.5%), largely graduated from US allopathic school (81%) and had a slight male predominance (54%), although the number of female applicants increased significantly over the study period. Attendance at a US allopathic medical school (OR=4.55, p b0.001), university-based general surgery training (OR=3.02, p b 0.001) and training at institutions that offer PS fellowships (OR = 3.36, p b 0.001) were associated with matriculation. Matriculants had a higher quantity of peer reviewed publications (median 11 vs. 6, p b 0.001) and published in high impact factor journals (p b 0.001). A total of 65 applicants reapplied at least once, of whom 32% successfully matriculated. Conclusions: PS applicants' medical school, residency, and research data points correlated with successful matriculation. These data may help guide general surgery residents and medical students aspiring to become pediatric surgeons.
Journal of Pediatric Urology
European Journal of Pediatric Surgery Reports
Introduction Cloacal malformations comprise a heterogeneous group of anomalies that are considere... more Introduction Cloacal malformations comprise a heterogeneous group of anomalies that are considered the most complex anorectal malformations (ARMs) in females. Precise evaluation to identify the unique anatomy prior to reconstruction with collaboration between colorectal surgeons, urologists, and gynecologists is vital. Here, we present a rare anatomical variation in a patient with a cloacal malformation which affected operative and postoperative management. Case description A 6-year-old female with cloaca who underwent colostomy, vaginostomy, and vesicostomy as a newborn presented for reconstruction. Her VACTERL workup was negative except for an atretic right kidney. Her ARM index included the cloaca, a normal spine, and sacrum with a lateral sacral ratio of 0.7, predicting good potential for bowel continence. Cystoscopy through the vesicostomy showed a small bladder with normal ureteral orifices, and a closed bladder neck, with no identifiable urethra. A cloacagram showed an atreti...
Journal of Pediatric Surgery
European Journal of Pediatric Surgery
: Background The posterior sagittal anorectoplasty (PSARP) used to repair an anorectal malformati... more : Background The posterior sagittal anorectoplasty (PSARP) used to repair an anorectal malformation (ARM) with a rectovestibular fistula involves incising the perineal body skin and the sphincter muscles and a posterior sagittal incision to the coccyx. Perineal body dehiscence is the most common and morbid complication post-PSARP which can have a negative impact on future bowel control. With consideration of all the other approaches described to repair this anomaly, we developed a perineal body sparing modification of the standard PSARP technique. Methods Four patients with ARM with a rectovestibular fistula were repaired with a perineal body sparing modified PSARP at a single institution between 2020 and 2021. The incision used was limited, involving only the length of the anal sphincter, with no incision anterior or posterior to the planned anoplasty. Dissection of the distal rectum and fistula was performed without cutting the perineal body. Once the distal rectum was mobilized off of the posterior vaginal wall and out of the vestibule, the perineal body muscles where the fistula had been were reinforced, and an anoplasty was then performed. Results Operative time was the same as for a standard PSARP. There were no intraoperative or postoperative complications. No postoperative dilations were performed. All patients healed well with an excellent cosmetic result. All are too young to assess for bowel control. Conclusion We present a new technique, a modification of the traditional PSARP for rectovestibular fistula, which spares the perineal body. This approach could eliminate the potential complication of perineal body dehiscence.
Journal of Pediatric Surgery
European Journal of Pediatric Surgery Reports
We present a rare case of a 2-year-old male patient referred for primary evaluation of constipati... more We present a rare case of a 2-year-old male patient referred for primary evaluation of constipation and ultimately treatment of Hirschsprung disease (HSCR) whose preoperative workup incidentally revealed a posterior paraspinal mass. Following the biopsy of the mass, the patient exhibited hypoventilation and hypoxia requiring a delayed extubation, raising suspicion for congenital central hypoventilation syndrome (CCHS). We focus on the known history of associations between HSCR and CCHS, in addition to recently found genetic mutations in paired-like homeobox 2B that link HSCR, CCHS, and neuroblastoma.
European Journal of Pediatric Surgery Reports
We present a case of a newborn male with imperforate anus who was found to have colonic triplicat... more We present a case of a newborn male with imperforate anus who was found to have colonic triplication with a high rectovesical fistula. The case is presented with a focus on surgical strategies for the management of this rare malformation.
Children
Cloaca is a rare, complex malformation encompassing the genitourinary and anorectal tract of the ... more Cloaca is a rare, complex malformation encompassing the genitourinary and anorectal tract of the female in which these tracts fail to separate in utero, resulting in a single perineal orifice. Prenatal sonography detects a few cases with findings such as renal and urinary tract malformations, intraluminal calcifications, dilated bowel, ambiguous genitalia, a cystic pelvic mass, or identification of other associated anomalies prompting further imaging. Multi-disciplinary collaboration between neonatology, pediatric surgery, urology, and gynecology is paramount to achieving safe outcomes. Perinatal evaluation and management may include treatment of cardiopulmonary and renal anomalies, administration of prophylactic antibiotics, ensuring egress of urine and evaluation of hydronephrosis, drainage of a hydrocolpos, and creation of a colostomy for stool diversion. Additional imaging of the spinal cord and sacrum are obtained to plan possible neurosurgical intervention as well as prognosti...
Journal of Pediatric Surgery
Journal of Surgical Research, Feb 1, 2007
Seminars in Pediatric Surgery, Dec 1, 2020
Lasting impact on children with an anorectal malformations with proper surgical preparation, resp... more Lasting impact on children with an anorectal malformations with proper surgical preparation, respect for anatomic principles, and precise surgical management,
Journal of Pediatric Surgery, Mar 1, 2023
Blood, Nov 16, 2005
Murine mesenchymal stem cells (mMSC) are capable of differentiation into multiple cell types in v... more Murine mesenchymal stem cells (mMSC) are capable of differentiation into multiple cell types in vitro, and as a result have been proposed as ideal candidates for the development of cellular based therapy for tissue repair. The distribution, engraftment, and differentiation properties of these cells in vivo have yet to be conclusively defined. Reports of mMSC engraftment and differentiation are confounded by issues of cell population purity, questions of fusion, a reliance on pathologic injury models to demonstrate significant engraftment levels, and immunofluorescent based cell tracking modalities which are prone to artifact and rely on subjective interpretation. In this study, we utilize a non-injured neonatal mouse model to demonstrate the fate of culture expanded, purified mMSC derived from the bone marrow of adult GFP transgenic mice. Following intravascular injection into Swiss Webster neonatal mice on the first day of life, mMSC were tracked with fluorescent stereomicroscopy and corresponding tissue specimens were collected and processed for histology and immunoperoxidase staining for GFP. mMSC were found to concentrate within the lungs with few, isolated cells visualized outside the lungs. Histological examination confirmed the presence of GFP expressing cells within the pulmonary vasculature but occurring as aggregates of bone. These nodules were found as early as 9 days after injection and persisted to 42 days after injection. These nodules were located within the confines of the vessel wall and were surrounded by an inflammatory infiltrate. There was no evidence of tissue invasion nor did these cells demonstrate malignant features. These bony aggregrates were also demonstrated after injection into C57Bl/6 congenic controls. Our findings indicate that mMSC are filtered by the pulmonary vasculature following intravenous injection thereby limiting their capacity to reach other tissues. The large adherent phenotype of these cells makes them prone to vessel lodgment, and this lodgment results is aberrant osteogenesis. These findings have major implications for intravascular stem cell based therapies for tissue repair.
Journal of Investigative Dermatology, Jul 1, 2008
Adult wound healing is characterized by an exuberant inflammatory response and scar formation. In... more Adult wound healing is characterized by an exuberant inflammatory response and scar formation. In contrast, scarless fetal wound healing has diminished inflammation, a lack of fibroplasia, and restoration of normal architecture. We have previously shown that fetal wounds produce less inflammatory cytokines, and the absence of IL-10, an anti-inflammatory cytokine, results in fetal scar formation. We hypothesized that increased IL-10 would decrease inflammation and create an environment conducive for regenerative healing in the adult. To test this hypothesis, a lentiviral vector expressing IL-10 and green fluorescent protein (GFP) (Lenti-IL-10) or GFP alone (Lenti-GFP) was injected at the wound site 48 hours before wounding. We found that both Lenti-IL-10 and Lenti-GFP were expressed in the wounds at 1 and 3 days post wounding. At 3 days, Lenti-IL-10-treated wounds demonstrated decreased inflammation and decreased quantities of all proinflammatory mediators analyzed with statistically different levels of IL-6, monocyte chemoattractant protein-1, and heat-shock protein 47. At 3 weeks, Lenti-GFP wounds demonstrated scar formation. In contrast, wounds injected with Lenti-IL-10 demonstrated decreased inflammation, a lack of abnormal collagen deposition, and restoration of normal dermal architecture. We conclude that lentivirus-mediated overexpression of IL-10 decreases the inflammatory response to injury, creating an environment conducive for regenerative adult wound healing.
Journal of Pediatric Surgery, Feb 1, 2023
European Journal of Pediatric Surgery Reports, 2022
Blood, Nov 16, 2005
Mesenchymal stem cells (MSCs) are multipotent cells of potential clinical interest given their ca... more Mesenchymal stem cells (MSCs) are multipotent cells of potential clinical interest given their capacity for in vitro expansion and intriguing immunologic properties. Studies using human and murine MSCs demonstrated their ability to suppress stimulated T cells in vitro. Consequently, much interest has been generated in the ability of MSCs to prevent graft versus host disease (GVHD). In fact, a limited number of case reports suggest a therapeutic role of human MSCs in the treatment of GVHD. Although encouraging, no systematic study has been performed to assess the ability of MSCs to suppress GVHD in vivo. In the current study we utilize a purified population of adult bone marrow derived murine MSCs previously shown to be immunosuppressive in vitro to evaluate the therapeutic potential in vivo of MSCs in an established model of murine GVHD. Methods: 8–12 week old C57Bl/6xBalb/c F1 mice were given 750cGy irradiation in a Cs135 gamma irradiator. 16–20 hours after irradiation, the mice received one of four groups of donor cells via lateral tail vein injection: 1) 10e6 C57Bl/6 (B6) bone marrow cells (BM) (n=5), 2) 10e6 B6 BM cells + 30e6 B6 spleen cells (n=12) (GVHD inoculum), 3) 10e6 B6 BM cells + 30e6 B6 spleen cells + 1e6 B6 MSCs (n=4) or 4) 10e6 B6 BM cells + 30e6 B6 spleen cells + 1.5e5 B6 MSCs (n=7). Mice were weighed and assessed for physical signs of GVHD such as ruffled fur, desquamation, diarrhea and hunching prior to receiving irradiation and on a weekly basis following irradiation and injection of the cellular inoculum. Results: In accordance with previous studies, the injection of 30e6 parental (B6) spleen cells combined with 10e6 (B6) parental BM cells into an F1 (B6xBalb/c) recipient following 750cGy irradiation resulted in a reliable model of GVHD. All mice receiving this inoculum demonstrated physical signs of GVHD including hunching and ruffled fur by three weeks post injection with the progression to desquamation and diarrhea by 5 weeks post injection. Similar to mice receiving the GVHD inoculum, mice receiving 30e6 B6 spleen cells + 10e6 B6 BM cells + either 1e6 B6 MSCs or 1.5e5 B6 MSCs demonstrated physical signs of GVHD by 3 weeks post injection. Control mice receiving only 10e6 B6 BM cells after 750cGy irradiation remained healthy and did not demonstrate any signs of GVHD. As demonstrated in figure 1, coinjection of either 1e6 B6 MSCs or 1.5e5 B6 MSCs with 30e6 B6 spleen cells + 10e6 B6 BM cells did not result in any significant change in weight loss compared to those mice receiving the GVHD inoculum. Similarly, the survival of mice receiving the GVHD inoculum was not improved by the coinjection of either 1e6 B6 MSCs or 1.5e5 B6 MSCs (25% vs 0% vs 28.57% at 6 weeks post injection). Conclusion: Previous studies have supported an in vitro immunosuppressive function of MSCs and a limited number of human studies have highlighted the potential ability of human MSCs to suppress GVHD. Despite these previous findings the current study demonstrates that the intravenous injection of MHC matched murine MSCs at the time of GVHD induction in an established murine model of GVHD does not affect the onset or severity of GVHD as measured by physical exam, weight loss and survival. Figure Figure
European Journal of Pediatric Surgery
Journal of Pediatric Surgery, 2019
Background: Pediatric surgery (PS) is among the most competitive fellowship opportunities for gen... more Background: Pediatric surgery (PS) is among the most competitive fellowship opportunities for general surgery residents. Prior investigations into factors associated with successful matriculation to PS have relied on surveys, which have inherent biases. Study design: Data were extracted from the Electronic Residency Application System for applicants from 2012 to 2017 and analyzed after stratification by matriculation status. Results: Data were gathered on a total of 444 applicants, of which 238 matriculated. The applicant pool was predominantly Caucasian (63.5%), largely graduated from US allopathic school (81%) and had a slight male predominance (54%), although the number of female applicants increased significantly over the study period. Attendance at a US allopathic medical school (OR=4.55, p b0.001), university-based general surgery training (OR=3.02, p b 0.001) and training at institutions that offer PS fellowships (OR = 3.36, p b 0.001) were associated with matriculation. Matriculants had a higher quantity of peer reviewed publications (median 11 vs. 6, p b 0.001) and published in high impact factor journals (p b 0.001). A total of 65 applicants reapplied at least once, of whom 32% successfully matriculated. Conclusions: PS applicants' medical school, residency, and research data points correlated with successful matriculation. These data may help guide general surgery residents and medical students aspiring to become pediatric surgeons.
Journal of Pediatric Urology
European Journal of Pediatric Surgery Reports
Introduction Cloacal malformations comprise a heterogeneous group of anomalies that are considere... more Introduction Cloacal malformations comprise a heterogeneous group of anomalies that are considered the most complex anorectal malformations (ARMs) in females. Precise evaluation to identify the unique anatomy prior to reconstruction with collaboration between colorectal surgeons, urologists, and gynecologists is vital. Here, we present a rare anatomical variation in a patient with a cloacal malformation which affected operative and postoperative management. Case description A 6-year-old female with cloaca who underwent colostomy, vaginostomy, and vesicostomy as a newborn presented for reconstruction. Her VACTERL workup was negative except for an atretic right kidney. Her ARM index included the cloaca, a normal spine, and sacrum with a lateral sacral ratio of 0.7, predicting good potential for bowel continence. Cystoscopy through the vesicostomy showed a small bladder with normal ureteral orifices, and a closed bladder neck, with no identifiable urethra. A cloacagram showed an atreti...
Journal of Pediatric Surgery
European Journal of Pediatric Surgery
: Background The posterior sagittal anorectoplasty (PSARP) used to repair an anorectal malformati... more : Background The posterior sagittal anorectoplasty (PSARP) used to repair an anorectal malformation (ARM) with a rectovestibular fistula involves incising the perineal body skin and the sphincter muscles and a posterior sagittal incision to the coccyx. Perineal body dehiscence is the most common and morbid complication post-PSARP which can have a negative impact on future bowel control. With consideration of all the other approaches described to repair this anomaly, we developed a perineal body sparing modification of the standard PSARP technique. Methods Four patients with ARM with a rectovestibular fistula were repaired with a perineal body sparing modified PSARP at a single institution between 2020 and 2021. The incision used was limited, involving only the length of the anal sphincter, with no incision anterior or posterior to the planned anoplasty. Dissection of the distal rectum and fistula was performed without cutting the perineal body. Once the distal rectum was mobilized off of the posterior vaginal wall and out of the vestibule, the perineal body muscles where the fistula had been were reinforced, and an anoplasty was then performed. Results Operative time was the same as for a standard PSARP. There were no intraoperative or postoperative complications. No postoperative dilations were performed. All patients healed well with an excellent cosmetic result. All are too young to assess for bowel control. Conclusion We present a new technique, a modification of the traditional PSARP for rectovestibular fistula, which spares the perineal body. This approach could eliminate the potential complication of perineal body dehiscence.
Journal of Pediatric Surgery
European Journal of Pediatric Surgery Reports
We present a rare case of a 2-year-old male patient referred for primary evaluation of constipati... more We present a rare case of a 2-year-old male patient referred for primary evaluation of constipation and ultimately treatment of Hirschsprung disease (HSCR) whose preoperative workup incidentally revealed a posterior paraspinal mass. Following the biopsy of the mass, the patient exhibited hypoventilation and hypoxia requiring a delayed extubation, raising suspicion for congenital central hypoventilation syndrome (CCHS). We focus on the known history of associations between HSCR and CCHS, in addition to recently found genetic mutations in paired-like homeobox 2B that link HSCR, CCHS, and neuroblastoma.
European Journal of Pediatric Surgery Reports
We present a case of a newborn male with imperforate anus who was found to have colonic triplicat... more We present a case of a newborn male with imperforate anus who was found to have colonic triplication with a high rectovesical fistula. The case is presented with a focus on surgical strategies for the management of this rare malformation.
Children
Cloaca is a rare, complex malformation encompassing the genitourinary and anorectal tract of the ... more Cloaca is a rare, complex malformation encompassing the genitourinary and anorectal tract of the female in which these tracts fail to separate in utero, resulting in a single perineal orifice. Prenatal sonography detects a few cases with findings such as renal and urinary tract malformations, intraluminal calcifications, dilated bowel, ambiguous genitalia, a cystic pelvic mass, or identification of other associated anomalies prompting further imaging. Multi-disciplinary collaboration between neonatology, pediatric surgery, urology, and gynecology is paramount to achieving safe outcomes. Perinatal evaluation and management may include treatment of cardiopulmonary and renal anomalies, administration of prophylactic antibiotics, ensuring egress of urine and evaluation of hydronephrosis, drainage of a hydrocolpos, and creation of a colostomy for stool diversion. Additional imaging of the spinal cord and sacrum are obtained to plan possible neurosurgical intervention as well as prognosti...