Long-term urology outcomes of anorectal malformation.

INTRODUCTION: Urological problems are a recognised feature of anorectal malformation (ARM). Previous assumptions of favourable long-term urinary outcomes are being challenged. OBJECTIVE: We hypothesised that urinary tract problems are common in ARM and frequently persist into adulthood. We retrospectively reviewed long-term renal and bladder outcomes in ARM patients. STUDY DESIGN: Patients with ARM born between 1984-2005 were identified from electronic hospital databases. Their case notes were reviewed. Renal outcomes included serum creatinine and the need for renal replacement therapy. Bladder outcomes included symptom review, bladder medication, need for intermittent catheterisation, videourodynamics and whether the patient had undergone augmentation cystoplasty. RESULT (TABLE 1): The case notes of 50 patients were reviewed. The median age at last follow up was 18 years (range 12-34 years). The level of fistula was noted to be high in 17 patients, intermediate in eight, and low in 10. Four had cloaca. Congenital urological abnormalities were present in 25 (50%). An abnormal spinal cord was present in 22 (44%) patients. VACTERL association occurred in 27 (54%). Chronic kidney disease stage II or above was found in 14 (28%) patients, of whom four required a renal transplant. Abnormal bladder outcomes were found in 39 (78%) patients. Augmentation cystoplasty with Mitrofanoff had been performed in 12. Of those who had not undergone cystoplasty, 17 had urinary symptoms, including urinary incontinence in 12. Of the 39 patients with abnormal bladder outcome, 19 (49%) did not have a spinal cord abnormality. There was no significant statistical association between level of ARM and abnormal renal outcome or presence of bladder abnormality. DISCUSSION: Adverse renal and bladder outcomes are common in our cohort of young people with ARM with a significantly higher incidence compared with current literature. We did not demonstrate an association between level of ARM or presence of spinal cord anomaly with persistent bladder problems. Congenital urological anomalies are more common in those who later have an abnormal renal outcome. Although this difference is statistically significant, one fifth of patients born with anatomically normal upper tracts develop reduced renal function, implying an important acquired component. CONCLUSION: Bladder problems and reduced renal function affect a significant proportion of young adults with ARM. Neither adverse outcome is reliably predicted from ARM level, congenital urological anomaly or spinal cord anomaly. We advise continued long-term bladder and kidney follow-up for all patients with ARM.

Understanding the consequence of COVID-19 on undergraduate medical education: Medical students' perspective.

The coronavirus disease 2019 pandemic has significantly influenced the normal operations of all human affairs on a global scale. Indeed, the pandemic has had a considerable impact on the delivery of medical education in the UK for both pre-clinical and clinical year students. In response to the escalating case fatality rate due to the pandemic, there has been widespread termination of clinical placements, face-to-face teaching sessions, and examinations that require a physical presence by UK medical schools. It is hoped that the cancellation of the aforementioned activities will greatly reduce the exposure of medical students to the coronavirus however, the consequences of these actions may pose substantial issues for the learning experience and professional development of medical students. One such issue is the lack of regular communication between students and personal tutors which may give rise to burnout within students and impede academic performance. Furthermore, the suspension of clinical placements may result in a gradual reduction in students' clinical skills competence. The practice of medicine is grounded upon the application of basic science which involves undertaking clinical procedures and as such, students may be at a disadvantage due to the missed opportunity to refine these essential skills. In this article, we provide an overview of the consequences of the COVID-19 pandemic on medical education, specifically regarding curriculum delivery and assessment of students. We also adopt a holistic approach by considering the impact of the pandemic on the mental wellbeing of medical students during this unprecedented time. We offer pragmatic suggestions to uphold the quality of medical education such as the implementation of virtual interprofessional education sessions to solve clinical vignettes and virtual consultation skills with simulated patients. We conclude with suggested areas for future research to examine the effectiveness of a virtual interprofessional education model on both short and long-term learning as well as encouraging medical students and academic staff to trial innovative methods of teaching. Despite the resultant complications of the pandemic on medical education, these challenging times may present a serendipitous opportunity for medical students to cultivate the personal attributes expected of a doctor in the face of adversity. In light of the pandemic, there is scope to reconsider the effectiveness of current medical education and welcome innovative methods of delivering education whilst ensuring quality. The combination of recent telecommunication developments with current teaching methodologies may positively change the future landscape of medical education.