Persistent cloaca: persistence of the challenge

Abstract

Background: Persistent cloaca or cloacal anomalies represent a special category of anorectal anomalies affecting the female sex with a reported incidence of about one in 25,000 live birth. The study included 34 cases of cloaca that were managed at our unit between 2003 through 2017. We retrospectively reviewed patients' records that included clinical presentation, investigations, operative data, and follow-up notes. Anatomically, we stratified cloaca into three types according to the level of urogenital confluence. A low confluence (type 1) was defined by being at or below the level of the lower border of pubic symphysis with a short common channel (11 cases). A high confluence (type 3) was defined by being at or above the level of the upper border of pubic symphysis (9 cases). Between the low and high types, we defined an intermediate type (type 2) where the urogenital confluence was behind the mid-portion of pubic symphysis (14 cases). Results: Renal anomalies were common association: solitary kidney in seven, pelvic kidney in two, and urinary tract dilatation (hydroureteronephrosis) in 12 cases. At follow-up, chronic renal insufficiency was detected in seven cases The prognosis for urinary continence was excellent in low confluence (type 1) cloaca. On the other hand, urinary incontinence was common among type 3 (high confluence) cloaca (62.5%). Conclusion: Renal anomalies represent a common association with cloaca and a major cause of morbidity. Efforts should be directed to preserve renal function during the initial management, and to preserve the continence potential following the definitive repair. Level of evidence: This is a case series with no comparison group (level IV).

Posterior Sinuplasty: A New Strategy for Managing Hydrocolpos in Cloaca—Case Series

“…Surgical treatment of cloaca represents a serious challenge [3,6,10]. Pena described vaginal separation from the urinary tract as technically difficult and very time consuming.…”

“…Surgical treatment of cloaca represents a serious challenge. 3 6 10 Peña described vaginal separation from the urinary tract as technically difficult and very time consuming. High rate of complications is probably related to devascularization of these fine structures during mobilization.…”

“… 12 Others prefer delaying vaginoplasty to early adolescence when the risk–benefit can be better assessed, and a more definitive procedure can be performed. 10 Another potential advantage for delaying vaginal surgery in such cases would be the improved vascularity of the genital tract under effect of postpubertal hormones. 5 We do agree that in simple forms of the anomaly (common sinus ∼1–2 cm), a low vagina can be fully corrected during the anorectoplasty with favorable and reproducible outcomes.…”