February 19Feb 19 quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth -"The confluence is not always readily apparent, especially in very masculinized patients who have a UGS resembling a male urethra. In these patients, one must actively look for a verumontanum-like structure with a small “utricular” opening in the proximal urethra. This is the confluence. A guidewire or ureteral catheter should be inserted into this communication through the cystoscope, and then the scope can be passed over the guide into the vagina. In almost all cases, we find it helpful to place a Fogarty catheter into the vagina and inflate the balloon (Fig. 68.1). Even in the smallest neonate, this can be done by passing the Fogarty catheter through the cystoscopic sheath and clamping the catheter with a hemostat after the balloon is inflated."
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