A Summary of the Cloaca Service Activity and Outcomes to Date
The team runs a monthly MDT clinic where our patients and their families have the opportunity to discuss management with all the professionals. Other assessments also take place the same day including ultrasound, blood tests, bladder function assessments and psychology sessions, in a way that mimics a ‘Day Hospital’ model. This offers several advantages to the family but also a comprehensive package of care with the benefit of discussions and coordination between the families and various professionals involved.
This graph shows how the number of patients we are seeing has increased since we started the service.
Operative activity has also increased with 4 reconstructions performed in 2013-2014 to 9 in 2017-2018. Larger numbers of examinations under anaesthetic and stoma closures are associated with the reconstructive surgery, as well as occasional revisional procedures. Primary reconstructions are those patients that had their first reconstruction performed by us at GOSH. Secondary reconstructions are those that had their first reconstruction elsewhere, and further reconstruction at GOSH.
The MDT service has been able to demonstrate an improvement in renal outcomes when compared to our historical cohort. Only 8% of our patients progress to stage 4 or 5 chronic kidney disease, which is a large improvement on the 29% in our historical cohort (Warne et al 2002). Other outcomes such as urinary and bowel continence can only be meaningfully understood with longer follow up, and we will investigate this as time goes by.
We have recently been awarded a small grant through the NIHR GOSH BRC PPIE Small Grants Scheme to conduct a Cloaca Open Day and Research Forum. The Patient and Public Involvement and Engagement (PPIE) Small Grants Scheme 2020 is specifically aimed at supporting researchers to actively involve and/or engage patients and the public in translational research aligning with the activity of existing GOSH BRC Research Themes. We hope to run this in 2021.