Surgical treatment of cloacal anomalies

From 1989-1998 14 patients were treated with cloacal anomalies: 5 typical c loacas (PC), 5 posterior cloacas, and 4 cloacal exstrophies (CE); 12 underw ent surgery. Four typical cloacas were resolved with posterior sagittal ano rectovagino-urethroplasty (PSARVUP), whereas in the 5th total urogenital mo bilization (TUM) was used. Three PCs were managed with transanorectal TUM a nd 2 with anterior TUM without opening the anal canal and rectum (without a protective colostomy). Two CEs were treated with atypical procedures. Two patients with CE died without surgery and 2 died after surgery due to compl ex associated anomalies. During postoperative follow-up of 1-8 years, 5 chi ldren had voluntary bowel movements and no soiling while the others had soi ling with or without enemas; 1 had stress incontinence; 3 were on clean int ermittent catheterization due to neurogenic bladder and were dry. PSARVUP provides a satisfactory result if there is no sacral anomaly. TUM m akes this operation easier to perform. In patients with a PC ii is sometime s possible using TUM to separate the urinary from the genital tract and rem ove the accessory urethra without opening the anus and rectum.