Clean intermittent catheterization as an initial management strategy provides for adequate preservation of renal function in newborns with persistent cloaca

Chalmers, David J.; Rove, Kyle O.; Wiedel, Cole A.; Tong, Suhong; Siparsky, Georgette L.; Wilcox, Duncan T.

doi:10.1016/j.jpurol.2015.05.014

Cited by 22 publications

(9 citation statements)

References 16 publications

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“…During performing contrast studies through the common channel (genitograms), the inserted catheter has been shown to pass preferentially into the vagina, and in many times, we fail to opacify the urinary bladder and urethra. This observation is supported by reports on successful management of hydrocolpos in cases of cloaca by CIC of the vagina in the neonatal period [4,21] . Therefore, we can expect the common urogenital sinus not to interfere with vaginal coitus in these cases.…”

Section: Discussionsupporting

confidence: 71%

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

AbouZeid

2017

JGS

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Purpose: To highlight a different concept for the urogenitoplasty in the management of cloaca and its possible implications on functional and cosmetic outcome. Patients and Methods: The study included six cases of cloaca who were recently managed during the period 2011 through 2015. Regarding urogenitoplasty, two cases with low urogenital confluence had a short common channel and were managed by introitoplasty in one and partial urogenital sinus mobilization in the other. One case with high distended vagina communicating close to the bladder neck was managed by vaginal pull-through, while keeping the common urogenital sinus to act as urethra. In between, three intermediate cases were also managed by introitoplasty, while keeping them with the common urogenital sinus uncorrected. Results: The follow-up period ranged from 2 to 6.5 years. Apart from the hypoplastic external genitalia, all cases included in the study had minimal perineal scaring compared with old cases that underwent extensive perineal 'urogenital' dissection. Urinary and stool incontinence was observed in one case that was associated with caudal regression syndrome. Another case that underwent vaginal pull-through had poor evacuation of the urinary bladder; this was managed by anticholinergics and clean intermittent catheterization. The rest of cases had voluntary bowel movements and spontaneous voluntary micturition. Conclusion: Considering the potential risk and complications of separating the vagina from the urethra in some cases of cloaca, it might be better from the functional and cosmetic point of view to perform just introitoplasty while keeping these girls with the common urogenital sinus uncorrected.

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Section: Discussionsupporting

confidence: 71%

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

AbouZeid

2017

JGS

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“…Gestational age was noted in 12 of the pregnancies that resulted in a live birth. Most of these pregnancies (8/12) were delivered prematurely, with the average gestational age of 32.5 (range, [28][29][30][31][32][33][34][35][36] weeks. These premature deliveries were most commonly the result of spontaneous premature rupture of membranes (PPROM) and not medically indicated deliveries.…”

Section: Resultsmentioning

confidence: 99%

“…Intermittent transperineal catheterization of the common channel and/or transabdominal vaginostomy have both been proposed. 35 Although the main concern is relief of the obstructed urinary tract and prevention of renal damage, complications of an undrained hydrocolpos such as peritonitis and pyocolpos could theoretically also affect the long-term fertility by causing inflammation of the fallopian tubes and vaginal tissue. 32 At present, no long-term data are available about the effect of urinary fetal ascites or hydrocolpos on future fertility.…”

Section: Fetal Ascites/hydrocolposmentioning

confidence: 99%

Obstetrical Outcomes in Adult Patients Born with Complex Anorectal Malformations and Cloacal Anomalies: A Literature Review

Vilanova-Sánchez

McCracken

Halleran

et al. 2019

Journal of Pediatric and Adolescent Gynecology

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a b s t r a c tPatients born with complex anorectal malformations often have associated M€ ullerian anomalies, which might affect fertility and obstetrical outcomes. Other vertebral-anorectal-tracheoesophageal-renal-limb associations, such as renal or cardiac anomalies, could also affect pregnancy intention, fertility rates, and recommendations about mode of delivery or obstetrical outcomes. Associated conditions present at birth, like hydrocolpos, could also potentially affect fertility. Depending on the complexity of the anomaly, primary reconstruction might include vaginoplasty, vaginal interposition, perineal body reconstruction, and extensive pelvic dissection. After the initial reconstruction, patients might have multiple additional surgeries for stoma reversal, bladder augmentation, and creation of conduits, all with potential for pelvic adhesions. Pregnancy intention, fertility rates, mode of delivery, and obstetrical outcomes data are limited in this patient population, making it challenging to counsel patients and their families. We sought to evaluate all available literature in an attempt to better counsel families. A PubMed literature search was undertaken to review this topic. Search terms of "cloaca," "anorectal malformation," "pregnancy," "cloacal exstrophy," "vaginal delivery," and "cesarean section" were used and citation lists from all identified articles were checked to ensure that all possible articles were included in the review. We also outline comorbidities from the fetal period to adulthood that might affect reproductive health. Of the articles on anorectal and cloacal anomalies, 13 reports were identified that covered obstetrical outcomes. They were in patients with previous anorectal malformation, cloaca, and cloacal exstrophy repair. Twenty-four pregnancies were reported in 16 patients. Two ectopic pregnancies, 5 spontaneous miscarriages, 1 triplet pregnancy, and 16 singleton pregnancies were reported with a total of 19 live births. Regarding the method of conception, 15/18 pregnancies occurred spontaneously and 3/18 were via assisted reproductive technology with in vitro fertilization. There were 19 live births, of which at least 8 were preterm. M€ ullerian anatomy was reported in 8 of 13 articles. Only 2 patients underwent vaginal delivery (1 patient with repaired cloaca malformation had an operative vaginal delivery and 1 patient with repaired imperforate anus with rectovaginal fistula had a normal spontaneous vaginal delivery). The remaining patients all underwent a cesarean section. There were no reported cases of maternal mortality, and maternal morbidity was limited to recurrent urinary tract infections and worsening chronic kidney disease. There is a paucity of information regarding obstetrical outcomes in adult anorectal and cloaca patients. However, patients with previous cloacal repairs have achieved pregnancy spontaneously, as well as with in vitro fertilization. Patients with repaired cloacal malformations are at increased risk of preterm birth and cesarean delivery. Most p...

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“…For example, urocolpos drainage may prevent urinary tract obstructions, infections, pyocolpos or, in severe cases, rupture and peritonitis. 23,24 Fortunately, CIC was effective in draining the hydrocolpos for the current patient, thus avoiding other more invasive procedures such as a vaginostomy or vesicostomy which can cause scarring and adhesions, potentially complicating subsequent surgeries. 20 …”

Section: Discussionmentioning

confidence: 95%

“…22 In such cases, management consists of drainage and decompression by catheterising the common channel or, if catheterisation fails, performing an ultrasound-guided percutaneous tube vaginostomy, an open vaginostomy/vesicostomy or a ureterostomy/nephrostomy. 9,21,23,24 In the event of a rupture, a laparotomy, peritoneal drainage and open vaginostomy are temporary solutions prior to definitive surgical correction. For example, urocolpos drainage may prevent urinary tract obstructions, infections, pyocolpos or, in severe cases, rupture and peritonitis.…”

Section: Discussionmentioning

confidence: 99%

A Case of Persistent Urogenital Sinus: Pitfalls and challenges in diagnosis

Tan

Shunmugan

et al. 2018

Sultan Qaboos Univ Med J

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Persistent urogenital sinus (PUGS) is a rare anomaly whereby the urinary and genital tracts fail to separate during embryonic development. We report a three-year-old female child who was referred to the Sabah Women & Children Hospital, Sabah, Malaysia, in 2016 with a pelvic mass. She had been born prematurely at 36 gestational weeks via spontaneous vaginal delivery in 2013 and initially misdiagnosed with neurogenic bladder dysfunction. The external genitalia appeared normal and an initial sonogram and repeat micturating cystourethrograms did not indicate any urogenital anomalies. She therefore underwent clean intermittent catheterisation. Three years later, the diagnosis was corrected following the investigation of a persistent cystic mass posterior to the bladder. At this time, a clinical examination of the perineum showed a single opening into the introitus. Magnetic resonance imaging of the pelvis revealed gross hydrocolpos and a genitogram confirmed a diagnosis of PUGS, for which the patient underwent surgical separation of the urinary and genital tracts.

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Clean intermittent catheterization as an initial management strategy provides for adequate preservation of renal function in newborns with persistent cloaca

Cited by 22 publications

References 16 publications

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

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

Obstetrical Outcomes in Adult Patients Born with Complex Anorectal Malformations and Cloacal Anomalies: A Literature Review

A Case of Persistent Urogenital Sinus: Pitfalls and challenges in diagnosis

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