Cloaca reconstruction: a new algorithm which considers the role of urethral length in determining surgical planning

Wood, Richard J.; Reck-Burneo, Carlos A.; DaJusta, Daniel; Ching, Christina B.; Jayanthi, R; Bates, D. Gregory; Fuchs, Molly; McCracken, Katherine; Hewitt, Geri; Levitt, Marc A.

doi:10.1016/j.jpedsurg.2017.10.022

Cited by 36 publications

(44 citation statements)

References 13 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%

“…However, separation of the vagina from the common urogenital sinus remained a real challenge. The concept of urogenital sinus mobilization then appeared [7] aiming to save operative time and blood loss that may result from a difficult vaginal separation [3]; but still the technique has its limitations that it cannot be applied in all situations [8].…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

confidence: 99%

Persistent cloaca: persistence of the challenge

et al. 2020

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“…A standard approach would advise that a <3-cm CC can potentially be managed with a TUM 1,2 ; however, in this case, there are additional factors to take into consideration. 1 Based on the cloacagram 3 performed in addition to the endoscopy, the reconstructive plan becomes clear.…”

Section: Discussionmentioning

confidence: 99%

“…The urethra, measured from its take off from the CC to the bladder neck is long (> 1.5 cm) which in general points to a situation amenable to a TUM. 1,4 However, in this case, both the urethral length and the length of the CC must simultaneously be considered. If one was to mobilize the urogenital complex by doing a TUM, the CC would be split to allow the urethral orifice to reach the perineum.…”

Section: Discussionmentioning

confidence: 99%

“…It is therefore advised that the CC plus the length of the urethra to be used as the final urethral length, 1,5 and this can be achieved by performing a urogenital separation. The vagina is removed from the back of the CC and it is repaired, thus the entire CC plus urethra becomes the patient's urethra, and the bladder neck remains in its original position.…”

Section: Discussionmentioning

confidence: 99%

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