Achieving Full Anatomical Correction in Girls with cloacal anomalies: A Necessity or an Overdoing?

AbouZeid, Amr Abdelhamid

doi:10.21608/jgs.2019.7646.1015

Cited by 3 publications

(1 citation statement)

References 24 publications

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“…Partial urogenital sinus mobilization is not suitable for all cases and may end with a high vagina. Total urogenital sinus mobilization is more liable for tissue ischaemia especially with a combined abdomino-perineal dissection [8], and still its long-term effect on the continence mechanism is questionable [3,16,17].…”

Section: Discussionmentioning

confidence: 99%

Persistent cloaca: persistence of the challenge

et al. 2020

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Background: Persistent cloaca or cloacal anomalies represent a special category of anorectal anomalies affecting the female sex with a reported incidence of about one in 25,000 live birth. The study included 34 cases of cloaca that were managed at our unit between 2003 through 2017. We retrospectively reviewed patients' records that included clinical presentation, investigations, operative data, and follow-up notes. Anatomically, we stratified cloaca into three types according to the level of urogenital confluence. A low confluence (type 1) was defined by being at or below the level of the lower border of pubic symphysis with a short common channel (11 cases). A high confluence (type 3) was defined by being at or above the level of the upper border of pubic symphysis (9 cases). 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 (14 cases). Results: Renal anomalies were common association: solitary kidney in seven, pelvic kidney in two, and urinary tract dilatation (hydroureteronephrosis) in 12 cases. At follow-up, chronic renal insufficiency was detected in seven cases The prognosis for urinary continence was excellent in low confluence (type 1) cloaca. On the other hand, urinary incontinence was common among type 3 (high confluence) cloaca (62.5%). Conclusion: Renal anomalies represent a common association with cloaca and a major cause of morbidity. Efforts should be directed to preserve renal function during the initial management, and to preserve the continence potential following the definitive repair. Level of evidence: This is a case series with no comparison group (level IV).

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Section: Discussionmentioning

confidence: 99%

Persistent cloaca: persistence of the challenge

et al. 2020

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The Cloaca

AbouZeid

Mohammad

2022

Atlas of Anorectal Anomalies

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Embryological Development of Anorectal Malformations: A Hypothesis

Levin

2024

Preprint

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The embryology of anorectal malformations (ARMs) remains largely speculative. While some authors suggest that ARMs arise from abnormal development of the cloaca, the embryonic cloaca never undergoes a stage that resembles any form of ARMs observed in neonates. In fact, certain claims made by clinicians contradict established scientific data. The aim of this study, based on our own X-ray functional studies of the anorectal zone in both healthy individuals and those with ARMs, as well as an analysis of existing literature, is to propose a hypothesis of embryonic development for ARMs that aligns with reliable scientific data. Results: The presence of a functioning anal canal in most patients, both with low and high types of ARMs, can be explained by the internal anal sphincter (IAS) migrating in a craniocaudal direction, creating an anal canal up to the subcutaneous layer opposite the anal fossa. When the IAS does not encounter the ectodermal rudiment, as evidenced by the absence of the anus, it deviates forward and upward, forming a narrow, rigid fistula. This process leads to the ectopic positioning of the anus on the perineum, vestibule, urethra, or vagina. What surgeons typically remove during the pull-through procedure, under the guise of excising a fistula, is actually a functioning anal canal. A short, rigid fistula forms in the wall of the organ through which the IAS penetrates. A thin, long, rigid fistula occurs when the IAS is displaced towards the root of the scrotum. Unlike a true cloaca, a persistent cloaca develops due to the penetration of the IAS through the vaginal wall before a cavity has formed within the vagina. As a result, the IAS creates a narrow long fistula that, in some cases, obstructs the emptying of the upper part of the vagina, leading to hydrocolpos. These patients typically have a normally functioning bladder and urethra, and in some cases, a functioning anal canal has been documented. Poor outcomes are the result of unnecessary and mutilating surgeries. It has also been demonstrated that what is often referred to as rectal atresia or stenosis is in the anal canal, approximately 1 cm from the anal verge. This anomaly likely arises from a failure in the breakdown of the membrane between the endodermal and ectodermal anal canal primordia in embryos with a length of 13.5-135 cm. The membrane can be excised via an anal approach, thereby preserving the anal canal. Embryology and anatomy of the so-called H-type ARM are presented. A classification of ARM has been proposed. Conclusion: This hypothesis is presented for scientific discussion.

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Achieving Full Anatomical Correction in Girls with cloacal anomalies: A Necessity or an Overdoing?

Cited by 3 publications

References 24 publications

Persistent cloaca: persistence of the challenge

Persistent cloaca: persistence of the challenge

The Cloaca

Embryological Development of Anorectal Malformations: A Hypothesis

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