The cloacal anomalies: Anatomical insights through a complex spectrum

Persistent cloaca: persistence of the challenge

“…In this report, we presented an overview on the surgical management of a rare disease in paediatric surgery. The report also included the outcome of the different surgical procedures, while referring to a new proposal for stratifying cloaca [13]. We did not assess gynaecological and sexual aspects as these will need longer follow-up and involvement of other specialities as well.…”

“…We believe the outcome is still less satisfactory even in highly specialized centres all over the world [1]. The great diversity and complexity of the cloacal spectrum may present an obstacle for a unified classification system [11,13]. The collaboration between different centres and specialities is needed to provide more suitable surgical solutions based on better understanding of the complex anatomy of the anomaly, which in turn can help to improve the outcome.…”

“…We have tried to overcome some of the abovementioned limitations concerning the way of measuring the common channel and urethra by using MRI routinely in the preoperative assessment of cases of cloaca. However, discussing these diagnostic challenges is beyond our scope in this report and has been studied extensively in a previous one [13].…”

“…2). This was defined preoperatively by MRI [13] and confirmed at cystoscopy. A low confluence (type 1) is defined by being at or below the level of the lower border of pubic symphysis with a short common channel (about 1 cm).…”

“…A high confluence (type 3) is close to the bladder neck (few mm) and is defined by being at or above the level of the upper border of pubic symphysis. 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 [13].…”