Urological management of cloacal anomalies

Background: A cloacal anomaly results from incomplete urorectal division an d is frequently associated with genitourinary abnormalities. Experience of the urological reconstruction of this entity is reported. Methods: Nine girls with cloacal malformation have been treated at the Osak a Medical Center in the past 9 years. Seven patients were detected by prena tal ultrasonography as having: megacystis (two patients); hydronephrosis (t wo patients); or hydrometrocolpos (three patients). Two patients underwent prenatal shunt placement between the enlarged bladder and the amniotic spac e. Results: For neonatal urinary diversion, four patients received cystostomy. Six of seven patients with associated hydrocolpos required intermittent ca theterization to decompress an enlarged vagina. Vesicoureteral reflux was d etected in 12 ureters of seven patients. Antireflux surgery was indicated i n four patients before definitive repair. Definitive reconstruction was per formed on eight patients. The posterior sagittal approach was used in all p atients. Vaginal reconstruction was done utilizing a perineal skin flap (on e patient), a tubularized vaginal flap (three patients), distal rectum (thr ee patients) and total urogenital mobilization (one patient). Postoperative ly, urethrovaginal fistula was created in one patient and complete occlusio n was seen in one patient. Conclusion: The anatomical variety of this entity determines the management options from in utero. It involves not only the creation of three perineal orifices, but also a continent, catheterizable urethra under the stabiliza tion of renal function. Accomplishment of the definitive repair requires th e combined expertise of experienced pediatric surgeons and pediatric urolog ists.