PRENATAL URINARY ASCITES AND PERSISTENT CLOACA - RISK-FACTORS FOR POOR DRAINAGE OF URINE OR MECONIUM

Purpose: The unique confluence of the urinary, genital and gastrointes tinal tracts in girls with persistent cloaca potentially results in ab errant drainage-of urine and meconium that may be characteristic, allo wing a prenatal diagnosis to be made. Materials and Methods: Three of our last 15 patients with cloacal anomalies presented with urinary asc ites due to intraperitoneal reflux through the genital system. In 3 fe male patients a long, narrow cloaca was associated with a high conflue nce of the urethra, vagina and rectum. All 3 patients ultimately under went creation of a cutaneous vesicostomy. Results: In all 3 cases cuta neous vesicostomy effectively diverted urine away from the cloaca befo re definitive repair. Conclusions: The urethra-like persistent cloaca may result in significant outflow resistance. When combined with high confluence, it may cause aberrant drainage of urine and/or meconium. W hen such problems are noted prenatally, they are likely to persist pos tnatally and require intervention.