Understanding cloacal anomalies

Abstract

Persistent cloaco is the most severe type of anorectal malformation encountered in children. Patients with cloacal anomalies have a high incidence of associated anomalies most commonly: urinary tract and spinal. Persistent cloaca remains a difficult reconstructive challenge but it is now possible to anatomically correct the defect with surgery in the majority of patients. This review discusses embryology, prenatal diagnosis, neonatal physical and radiological findings. A summary of early management and investigation is provided and the commonest surgical reconstruction techniques are discussed. The main goals of surgical reconstruction are the achievement of bowel and bladder control for the child and normal sexual function in adult life. Although the majority of cloaca patients can achieve faecal and urinary continence with the surgical reconstructive procedures performed today, many require additional/multiple urological procedures to achieve continence, treat bladder dysfunction and to protect renal function. One half of patients will develop renal failure, so regular and life long surveillance is mandatory. Due to the high number of associated gynaecological problems all patients should be assessed by a paediatric gynaecologist at puberty.

Persistent cloaca presenting with a perineal cyst: Prenatal ultrasound and magnetic resonance imaging findings

“…However, in humans, persistent cloaca is a complex malformation with a wide spectrum of severities and can be associated with vertebral, pulmonary, cardiac, and genitourinary tract abnormalities. 4 In human embryos, the cloaca is a transient structure and is divided by 6 weeks of gestation, resulting in a urogenital sinus anteriorly and a separate hindgut posteriorly. 4 Warne et al 5 suggested that cloacal anomalies be considered prenatally in any female fetus with bilateral hydronephrosis, a poorly visualized bladder, and a cystic lesion arising from the pelvis.…”

“…4 In human embryos, the cloaca is a transient structure and is divided by 6 weeks of gestation, resulting in a urogenital sinus anteriorly and a separate hindgut posteriorly. 4 Warne et al 5 suggested that cloacal anomalies be considered prenatally in any female fetus with bilateral hydronephrosis, a poorly visualized bladder, and a cystic lesion arising from the pelvis. However, prenatal diagnosis of persistent cloaca is not always easy.…”

Cloacal and Urogenital Sinus Anomalies

“…Three systems (urinary, genital, and intestinal) lead into a common channel that opens in the perineum (Fig. 14.7 ) [ 17 ]. This means that there is a connection between the vagina, the rectum, and the bladder at different levels and stages of development.…”

Pediatric Bladder Disorders

“…In girls, cloaca malformation is an early (third to fourth week of gestation) dysembryonic disorder with a persistent common cavity composed of the lower urinary tract, genital tract, and gastrointestinal tract [77]. A urogenital sinus malformation is (only) the confluence of the urinary and genital tracts.…”