Alberto Pena

Summary

Affiliation: Cincinnati Children's Hospital Medical Center
Country: USA

Publications

  1. ncbi request reprint Surgical management of cloacal malformations
    Alberto Pena
    Department of Pediatric Surgery, Schneider Children s Hospital, 269 01, 76th Avenue, New Hyde Park, NY 11040, USA
    Semin Neonatol 8:249-57. 2003
  2. ncbi request reprint Outcomes from the correction of anorectal malformations
    Marc A Levitt
    Division of Pediatric Surgery, Cincinnati Children s Hospital Medical Center, Ohio 45229, USA
    Curr Opin Pediatr 17:394-401. 2005
  3. pmc Bowel management for the treatment of pediatric fecal incontinence
    Andrea Bischoff
    Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229, USA
    Pediatr Surg Int 25:1027-42. 2009
  4. doi request reprint Posterior cloaca--further experience and guidelines for the treatment of an unusual anorectal malformation
    Alberto Pena
    The Colorectal Center for Children, Division of Pediatric Surgery, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229 3039, USA
    J Pediatr Surg 45:1234-40. 2010
  5. ncbi request reprint Reoperations in Hirschsprung disease
    Alberto Pena
    Department of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital, Cincinnati, OH 45229, USA
    J Pediatr Surg 42:1008-13; discussion 1013-4. 2007
  6. ncbi request reprint Reoperations in anorectal malformations
    Alberto Pena
    Department of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital, Cincinnati, OH 45229, USA
    J Pediatr Surg 42:318-25. 2007
  7. doi request reprint The transpubic approach for the correction of complex anorectal and urogenital malformations
    Alberto Pena
    Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Pediatr Surg 46:2316-20. 2011
  8. ncbi request reprint Colostomy in anorectal malformations: a procedure with serious but preventable complications
    Alberto Pena
    Colorectal Center for Children Cincinatti Children s Hospital Medical Center, Surgery and Pediatrics University of Cincinnati, Cincinnati, OH 45229, USA
    J Pediatr Surg 41:748-56; discussion 748-56. 2006
  9. ncbi request reprint The role of a colon resection in combination with a Malone appendicostomy as part of a bowel management program for the treatment of fecal incontinence
    Balgopal Eradi
    Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Pediatr Surg 48:2296-300. 2013
  10. doi request reprint The appendix as a conduit for antegrade continence enemas in patients with anorectal malformations: lessons learned from 163 cases treated over 18 years
    Shawn J Rangel
    Department of Pediatric Surgery, Children s Hospital Boston, Harvard School of Medicine, Boston, MA 02115, USA
    J Pediatr Surg 46:1236-42. 2011

Collaborators

Detail Information

Publications50

  1. ncbi request reprint Surgical management of cloacal malformations
    Alberto Pena
    Department of Pediatric Surgery, Schneider Children s Hospital, 269 01, 76th Avenue, New Hyde Park, NY 11040, USA
    Semin Neonatol 8:249-57. 2003
    ..All patients must be followed on a long-term basis in order to evaluate sexual function and care for obstetric issues...
  2. ncbi request reprint Outcomes from the correction of anorectal malformations
    Marc A Levitt
    Division of Pediatric Surgery, Cincinnati Children s Hospital Medical Center, Ohio 45229, USA
    Curr Opin Pediatr 17:394-401. 2005
    ..This review describes recent advances in the management of anorectal malformations, including prenatal diagnosis, newborn treatment, surgical correction, and postoperative care...
  3. pmc Bowel management for the treatment of pediatric fecal incontinence
    Andrea Bischoff
    Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229, USA
    Pediatr Surg Int 25:1027-42. 2009
    ..The main characteristics of the program include the identification of the characteristics of the colon of each patient; finding the specific type of enema that will clean that colon and the radiological monitoring of the process...
  4. doi request reprint Posterior cloaca--further experience and guidelines for the treatment of an unusual anorectal malformation
    Alberto Pena
    The Colorectal Center for Children, Division of Pediatric Surgery, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229 3039, USA
    J Pediatr Surg 45:1234-40. 2010
    ..The term posterior cloaca refers to a malformation in which the urethra and vagina are fused, forming a urogenital sinus that deviates posteriorly to open in the anterior rectal wall or immediately anterior to the anus...
  5. ncbi request reprint Reoperations in Hirschsprung disease
    Alberto Pena
    Department of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital, Cincinnati, OH 45229, USA
    J Pediatr Surg 42:1008-13; discussion 1013-4. 2007
    ..We sought to identify causes of preventable complications related to operations for Hirschsprung disease...
  6. ncbi request reprint Reoperations in anorectal malformations
    Alberto Pena
    Department of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital, Cincinnati, OH 45229, USA
    J Pediatr Surg 42:318-25. 2007
    ....
  7. doi request reprint The transpubic approach for the correction of complex anorectal and urogenital malformations
    Alberto Pena
    Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Pediatr Surg 46:2316-20. 2011
    ..The transpubic approach has been used mainly to treat urethral injuries and prostate cancer. There are no reports describing this approach in anorectal malformations...
  8. ncbi request reprint Colostomy in anorectal malformations: a procedure with serious but preventable complications
    Alberto Pena
    Colorectal Center for Children Cincinatti Children s Hospital Medical Center, Surgery and Pediatrics University of Cincinnati, Cincinnati, OH 45229, USA
    J Pediatr Surg 41:748-56; discussion 748-56. 2006
    ..The procedure is associated with several significant complications...
  9. ncbi request reprint The role of a colon resection in combination with a Malone appendicostomy as part of a bowel management program for the treatment of fecal incontinence
    Balgopal Eradi
    Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Pediatr Surg 48:2296-300. 2013
    ..We have found that some patients may benefit from both procedures...
  10. doi request reprint The appendix as a conduit for antegrade continence enemas in patients with anorectal malformations: lessons learned from 163 cases treated over 18 years
    Shawn J Rangel
    Department of Pediatric Surgery, Children s Hospital Boston, Harvard School of Medicine, Boston, MA 02115, USA
    J Pediatr Surg 46:1236-42. 2011
    ..The purpose of this study was to examine our experience with the ACE procedure using the appendix as a catheterizable conduit in children with anorectal malformations (ARMs)...
  11. ncbi request reprint Transanal, full-thickness, Swenson-like approach for Hirschsprung disease
    Marc A Levitt
    Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA Electronic address
    J Pediatr Surg 48:2289-95. 2013
    ....
  12. doi request reprint Rectal atresia and stenosis: unique anorectal malformations
    Miller Hamrick
    Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Pediatr Surg 47:1280-4. 2012
    ..We present a surgical technique for the management of these patients, as well as their unique clinical concerns and outcomes...
  13. doi request reprint Management of H-type rectovestibular and rectovaginal fistulas
    Taiwo A Lawal
    Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Pediatr Surg 46:1226-30. 2011
    ..We describe our approach and outcome in the management of these patients...
  14. doi request reprint Acquired posterior urethral diverticulum following surgery for anorectal malformations
    Shumyle Alam
    Division of Pediatric Urology, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229 3039, USA
    J Pediatr Surg 46:1231-5. 2011
    ..One complication, the posterior urethral diverticulum, may have untoward consequences if not recognized and treated...
  15. doi request reprint Cloacal exstrophy--pull-through or permanent stoma? A review of 53 patients
    Marc A Levitt
    Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Pediatr Surg 43:164-8; discussion 168-70. 2008
    ....
  16. doi request reprint Neoappendicostomy in the management of pediatric fecal incontinence
    Kaveer Chatoorgoon
    Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Pediatr Surg 46:1243-9. 2011
    ..In patients whose appendix has been removed, a neo-appendix can be created. We describe our approach and experience with this procedure as an option for surgeons managing children with fecal incontinence...
  17. doi request reprint Pitfalls and challenges of cloaca repair: how to reduce the need for reoperations
    Marc A Levitt
    Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Pediatr Surg 46:1250-5. 2011
    ..We have encountered a unique group of complications in referred patients after failed attempted repairs elsewhere and chose to review this experience with the hope of identifying pitfalls to avoid during the primary repair...
  18. doi request reprint Cloacal malformations: lessons learned from 490 cases
    Marc A Levitt
    Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA
    Semin Pediatr Surg 19:128-38. 2010
    ..Surgeons who repair Group B malformations require special training in urology; the operations are prolonged and technically demanding, and the functional results are not as good as in group A...
  19. doi request reprint Evaluation and treatment of the patient with Hirschsprung disease who is not doing well after a pull-through procedure
    Marc A Levitt
    Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA
    Semin Pediatr Surg 19:146-53. 2010
    ..Both of these patient types can be systematically treated with a combination of bowel management, dietary changes, and laxatives, and, potentially, a redo operation, with the goal of having a clean, and happy child...
  20. doi request reprint The Hirschsprungs patient who is soiling after what was considered a "successful" pull-through
    Marc A Levitt
    Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, Division of Pediatric Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH 45229, USA
    Semin Pediatr Surg 21:344-53. 2012
    ..These patients can be systematically evaluated and successfully treated with a combination of bowel management, dietary changes, and laxatives, and, in certain circumstances, a reoperation...
  21. doi request reprint Redo pull-through in Hirschsprung's [corrected] disease for obstructive symptoms due to residual aganglionosis and transition zone bowel
    Taiwo A Lawal
    Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Pediatr Surg 46:342-7. 2011
    ..We aimed to review the management of patients who had this complication and offer suggestions on how to avoid it...
  22. ncbi request reprint Surgery and constipation: when, how, yes, or no?
    Marc A Levitt
    Division of Pediatric Surgery, Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio, USA
    J Pediatr Gastroenterol Nutr 41:S58-60. 2005
  23. pmc Prenatal counseling for cloaca and cloacal exstrophy-challenges faced by pediatric surgeons
    Andrea Bischoff
    Colorectal Center for Children, Division of Pediatric Surgery, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229, USA
    Pediatr Surg Int 28:781-8. 2012
    ..The purpose of this review is to analyze our experience in prenatally diagnosed cloaca or cloacal exstrophy and to provide some guidelines for prenatal counseling of these complex congenital anomalies...
  24. doi request reprint Update on the management of anorectal malformations
    Andrea Bischoff
    Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229, USA
    Pediatr Surg Int 29:899-904. 2013
    ..The goal of this article is to give a brief update on the current management of patients with anorectal malformation, based on the multiple lessons learned during this period...
  25. ncbi request reprint Laparoscopic-assisted PSARP - the advantages of combining both techniques for the treatment of anorectal malformations with recto-bladderneck or high prostatic fistulas
    Andrea Bischoff
    Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Pediatr Surg 48:367-71. 2013
    ..The aim of this study was to present an alternative way to use both the posterior sagittal approach combined with laparoscopy for the repair of select cases of anorectal malformation (ARM)...
  26. ncbi request reprint Vaginal switch--a useful technical alternative to vaginal replacement for select cases of cloaca and urogenital sinus
    Andrea Bischoff
    Colorectal Center for Children, Division of Pediatric Surgery, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Pediatr Surg 48:363-6. 2013
    ..The aim of this study was to describe the indications, technical details, and complications of a surgical maneuver designed to repair the vagina in select cases of cloaca and urogenital sinus...
  27. ncbi request reprint MRI of acquired posterior urethral diverticulum following surgery for anorectal malformations
    Daniel J Podberesky
    Department of Radiology, Cincinnati Children s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
    Pediatr Radiol 41:1139-45. 2011
    ..Posterior urethral diverticulum (PUD) is one of the most common postoperative complications associated with anorectal malformation (ARM) correction...
  28. doi request reprint Laparoscopic-assisted Malone appendicostomy in the management of fecal incontinence in children
    Taiwo A Lawal
    Division of Pediatric Surgery, Department of Surgery, Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229, USA
    J Laparoendosc Adv Surg Tech A 21:455-9. 2011
    ..We present our experience using this approach for fecal incontinence patients and technical modifications to reduce complications...
  29. doi request reprint Hydrocolpos in cloacal malformations
    Andrea Bischoff
    Colorectal Center for Children, Division of Pediatric Surgery, Cincinnati Children s Hospital Medical Center, ML 2023, Cincinnati, OH, USA
    J Pediatr Surg 45:1241-5. 2010
    ..The purpose of this report is to increase the index of suspicion for hydrocolpos in patients with cloaca and to describe our approach for its treatment with the hope that errors in the management of hydrocolpos can be avoided...
  30. ncbi request reprint Urologic injuries associated with repair of anorectal malformations in male patients
    Andrew R Hong
    Division of Pediatric Surgery, Schneider Children s Hospital, New Hyde Park, NY, USA
    J Pediatr Surg 37:339-44. 2002
    ..Serious injuries to the urinary tract may occur during the repair of an anorectal malformation, especially in boys. This review of a large series of patients characterizes factors that may either lead to, or prevent, those injuries...
  31. ncbi request reprint Colonic inertia disorders in pediatrics
    Alberto Pena
    Division of Pediatric Surgery, Schneider Children s Hospital, North Shore Long Island Jewish Health System and Albert Einstein College of Medicine, New Hyde Park, New York, USA
    Curr Probl Surg 39:666-730. 2002
  32. doi request reprint Complex cloacal malformations: use of rotational fluoroscopy and 3-D reconstruction in diagnosis and surgical planning
    Manish N Patel
    Division of Interventional Radiology, Department of Radiology, Cincinnati Children s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
    Pediatr Radiol 42:355-63. 2012
    ....
  33. ncbi request reprint Laparoscopy and its use in the repair of anorectal malformations
    Andrea Bischoff
    Colorectal Center for Children, Division of Pediatric Surgery, Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio 45229, USA
    J Pediatr Surg 46:1609-17. 2011
    ..There remains a significant debate about whether these expectations have been fulfilled...
  34. pmc Total colonic aganglionosis: a surgical challenge. How to avoid complications?
    Andrea Bischoff
    Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229, USA
    Pediatr Surg Int 27:1047-52. 2011
    ..Long-term results are suboptimal and complications are very common. We analyzed our experience to formulate recommendations to achieve better results and avoid complications and sequelae...
  35. doi request reprint Transanal rectosigmoid resection for severe intractable idiopathic constipation
    Marc A Levitt
    Division of Pediatric General and Thoracic Surgery, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Pediatr Surg 44:1285-90; discussion 1290-1. 2009
    ..Idiopathic constipation is a source of significant morbidity in children. A subset of patients is refractory to medical therapy and requires surgical intervention. We present a novel surgical technique for the management of these patients...
  36. doi request reprint Rectovestibular fistula--rarely recognized associated gynecologic anomalies
    Marc A Levitt
    Department of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Pediatr Surg 44:1261-7; discussion 1267. 2009
    ..Associated gynecologic defects are rarely mentioned in the literature but may have serious clinical implications if undetected. The definitive repair of the ARM offers an opportunity for diagnosis and treatment of these conditions...
  37. doi request reprint Hirschsprung disease and fecal incontinence: diagnostic and management strategies
    Marc A Levitt
    Department of Surgery, Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, University of Cincinnati College of Medicine, OH 45229, USA
    J Pediatr Surg 44:271-7; discussion 277. 2009
    ..If it does, it presents a formidable challenge. The purpose of this study was to describe the causes of fecal incontinence and present our algorithm for its treatment...
  38. ncbi request reprint Rectovaginal fistula: a common diagnostic error with significant consequences in girls with anorectal malformations
    Nelson G Rosen
    Division of Pediatric Surgery, Schneider Children s Hospital, New Hyde Park, NY 11040, USA
    J Pediatr Surg 37:961-5; discussion 961-5. 2002
    ..Rectovaginal fistula is a term that continues to be used frequently to describe girls with anorectal malformations. This study attempts to evaluate the true frequency of this anomaly and the consequences of its misdiagnosis...
  39. pmc Anorectal malformations
    Marc A Levitt
    Department of Pediatric Surgery, Cincinnati Children s Hospital, University of Cincinnati, Cincinnati, Ohio 45229, USA
    Orphanet J Rare Dis 2:33. 2007
    ..For these patients, an effective bowel management program, including enema and dietary restrictions has been devised to improve their quality of life...
  40. doi request reprint Prenatal diagnosis of cloacal malformations
    Andrea Bischoff
    Colorectal Center for Children, Division of Pediatric Surgery, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229, USA
    Pediatr Surg Int 26:1071-5. 2010
    ..9% of screened cases. In cloacas, these numbers are unknown. We speculate that some images from prenatal ultrasound studies may suggest the diagnosis of cloaca, but are not recognized because of a lack of suspicion for this diagnosis...
  41. ncbi request reprint Increased heritability of certain types of anorectal malformations
    Richard A Falcone
    Division of Pediatric and Thoracic Surgery, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229 3039, USA
    J Pediatr Surg 42:124-7; discussion 127-8. 2007
    ..Various lines of evidence point to genetic causes for the diverse spectrum of anorectal malformations (ARMs); we therefore studied patterns of heritability in a large case series...
  42. ncbi request reprint The "rescue operation" for patients with cloacal exstrophy and its variants
    Andrea Bischoff
    Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH, 45229, USA
    Pediatr Surg Int 30:723-7. 2014
    ..These patients benefit from a "rescue operation" to give them the best opportunity to be future pull-through candidates...
  43. pmc Defining the molecular pathologies in cloaca malformation: similarities between mouse and human
    Laura A Runck
    Division of Developmental Biology, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
    Dis Model Mech 7:483-93. 2014
    ..Moreover, deranged Shh and BMP signaling is correlated with severe anorectal malformations in both mouse and humans. ..
  44. doi request reprint Covered cloacal exstrophy--a poorly recognized condition: hints for a correct diagnosis
    Andrea Bischoff
    Colorectal Center for Children, Division of Pediatric Surgery, Cincinnati Children s Hospital Medical Center, Cincinnati, OH, USA Electronic address
    J Pediatr Surg 48:2389-92. 2013
    ..Covered cloacal exstrophy requires a high index of suspicion for its diagnosis. Low implantation of the umbilical cord, separated pubic bones, and anorectal malformation are the most common signs...
  45. ncbi request reprint Coloboma and anorectal malformations: a rare association with important clinical implications
    Giulia Brisighelli
    Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229, USA
    Pediatr Surg Int 29:905-12. 2013
    ..In a patient with an anorectal malformation (ARM), the presence of a coloboma is commonly associated with other serious anomalies...
  46. ncbi request reprint Fetal MRI clues to diagnose cloacal malformations
    Maria A Calvo-Garcia
    Department of Radiology, MLC 5031, Cincinnati Children s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
    Pediatr Radiol 41:1117-28. 2011
    ..Prenatal US detection of cloacal malformations is challenging and rarely confirms this diagnosis...
  47. doi request reprint Treatment of fecal incontinence with a comprehensive bowel management program
    Andrea Bischoff
    Department of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Pediatr Surg 44:1278-83; discussion 1283-4. 2009
    ..A successful ACE may not help a patient without such management. Valuable lessons were learned by implementation of bowel management in 495 fecally incontinent patients...
  48. pmc Colostomy closure: how to avoid complications
    Andrea Bischoff
    Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229, USA
    Pediatr Surg Int 26:1087-92. 2010
    ..We now have focused in the morbidity related to the colostomy closure. The technical details that might have contributed to the minimal morbidity we experienced are described...
  49. doi request reprint The morbidity of constipation in patients with anorectal malformations
    Marc A Levitt
    Colorectal Center for Children, Cincinnati Children s Hospital, Division of Pediatric Surgery, University of Cincinnati, Cincinnati, Ohio 45229, USA
    J Pediatr Surg 45:1228-33. 2010
    ..Constipation in anorectal malformations (ARM) is extremely common, particularly in the lower types. Failure to adequately treat it can lead to significant morbidity...
  50. ncbi request reprint The posterior sagittal approach for recurrent genitourinary pathology
    Shumyle Alam
    Department of Pediatric Surgery, Cincinnati Children s Medical Center, Cincinnati, Ohio, USA
    J Urol 178:1668-71; discussion 1671. 2007
    ..In the setting of revisional surgery abdominal or perineal approaches may not provide the same level of exposure to the lower urinary tract...