Preoperative evaluation of persistent cloaca using contrast-enhanced ultrasound in an infant

Lin, Xueyun; Xu, Xinyu; Yang, Yuping; Wu, Jihuai; Xia, Xian; Chen, Xiaodong

doi:10.11152/mu-2039

Cited by 2 publications

(1 citation statement)

References 9 publications

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“…7 Contrast enhanced ultrasound has also been utilized in order to delineate the location of the rectovaginal fistula, length of the common channel, distance from bladder neck to common channel, and from urethra to perineum. 16 Common UGS is most commonly diagnosed by the presence of atypical genitalia at birth. However, in unclear cases, pelvic ultrasound can be useful in diagnosis.…”

Section: Postnatal Ultrasoundmentioning

confidence: 99%

3D Fluoroscopic imaging facilitates reconstruction of common urogenital sinus and cloacal anomalies

Li¹

2022

Insight Urol

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Cloacal anomalies and common urogenital sinus are rare structural abnormalities in hindgut and urogenital development. Surgical correction in childhood is often indicated to create normal external genital anatomy, allow for adequate bladder and vaginal drainage, and create the appropriate anorectal opening in patients with persistent cloaca. Understanding the anatomy and relationships between the pelvic organs is critical as there is a drastic variation in potential surgical approaches to the repair. Traditional imaging modalities such as pelvic ultrasound, magnetic resonance imaging, and two-dimensional fluoroscopic imaging have been utilized to delineate the pelvic anatomy for facilitation of surgical planning. Limitations to these modalities include the inability to adequately dilate structures and the difficulty in identifying the common confluence, or where the structures ultimately coalesce within the pelvis. In this article we describe the utilization of three-dimensional rotational fluorosco- py in combination with examination under anesthesia to provide optimal clarity of anatomy. Examination under anesthesia, specifically cystoscopy and vaginoscopy, helps the surgeon to visualize the anatomy and to place catheters in the correct lumens. Contrast material can then be injected into the catheters to dilate the bladder, vagina, and mucous fistula for fluoroscopic imaging. The rotational images can then be reconstructed in three dimensions to create a roadmap for the surgeons, providing accurate description of the location of the confluence, distance to the introitus and other critical measurements. We believe that three-dimensional rotation fluoroscopy is an underutilized diagnostic modality in the evaluation and surgical planning in patients with urogenital sinus and cloacal anomalies and should be considered by surgeons prior to proceeding with corrective surgery.

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Section: Postnatal Ultrasoundmentioning

confidence: 99%

3D Fluoroscopic imaging facilitates reconstruction of common urogenital sinus and cloacal anomalies

Li¹

2022

Insight Urol

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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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Preoperative evaluation of persistent cloaca using contrast-enhanced ultrasound in an infant

Cited by 2 publications

References 9 publications

3D Fluoroscopic imaging facilitates reconstruction of common urogenital sinus and cloacal anomalies

3D Fluoroscopic imaging facilitates reconstruction of common urogenital sinus and cloacal anomalies

Embryological Development of Anorectal Malformations: A Hypothesis

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