Subpubic Sinus: A Remnant of Cloaca

Abstract

A 14-month-old girl had purulent discharge from a sinus over the subpubic region for 2 weeks. Radiography and voiding cystourethrography revealed a 4.5 cm. long fistula extending to the retropubic region without any connection to the lower urinary tract. The fistula was excised. Histological findings revealed that the fistula had 3 different types of epithelium: stratified squamous, transitional and columnar. Clinical and pathological findings indicated that the sinus was most likely a remnant of the cloaca.

Congenital prepubic sinus—An aborted dorsal urethral duplication or a cloacal remnant?

“…Routine and immunohistochemical staining of tract in patients reported here and in literature; specifically, the reports by Huang et al, Chou et al and Balster et al, val-idates the presence of transitional, columnar and squamous epithelium in the lining. It seems that CPS is an aborted dorsal urethral duplication as described by Stephen et al, (type 3) or a cloacal remnant [10][11][12][13][14][15][16]. Stratified squamous and transitional epithelium can be found in urinary system (allantois) but columnar epithelium originates only from hindgut.…”

“…Stratified squamous and transitional epithelium can be found in urinary system (allantois) but columnar epithelium originates only from hindgut. Thus, the most likely source of 3 different type of epithelium in the lining of sinus is residual cloacal membrane [11]. It is postulated by Tsukamoto et al that during the embryonic development, the umbilicophallic groove traps a small share of cloacal membrane during its migration from the base of umbilical cord and tubularization following longitudinal growth of embryo [8].…”

Congenital Prepubic Sinus in an Adolescent Female: A Case Report and Review of the Literature

“…Table 1 summarizes the 17 female cases of CPS found in literature to date. Theories surrounding etiology include anomaly of abdominal wall closure 3 and persistent remnant of the cloaca, 8,12 but in most case reports, it appears to be a variant of dorsal urethral duplication. 14 Support for this arises from the presence of squamous epithelium distally and transitional epithelium in the proximal part of the sinus with surrounding smooth muscle ( Table 1).…”

Congenital prepubic sinus: A variant of epispadiac dorsal urethral duplication

“…(3) The third theory is that it is a congenital fistula of the primitive urogenital sinus, with three anatomic subtypes depending on the direction of the sinus tract: high, toward the urachal remnant; middle, toward the bladder; and low, toward the prostatic urethra [9]. 4The last theory suggests that it is a remnant of the cloaca [10]. Of all these theories, reports supporting the anomaly of dorsal urethral duplication predominate [1,3,5e8,11].…”