Correction of persistent cloaca in children: experience and analysis of treatment results

Abstract

Introduction. Cloaca is one of the most difficult to be corrected varieties of the pathology of the anorectal zone, occurring with a frequency of 1 case per 40 000–25 000 live births. Purpose: аnalysis of diagnostic methods and surgical correction, treatment outcomes of children with cloacal malformations. Materials and methods . The article analyzed 16 cases of surgical treatment of cloacal anomalies based on the Irkutsk Municipal Pediatric Clinical Hospital in Irkutsk for the period from 2008 to the present. Gender composition: girls – 14 (87,5%), genotype (46XX – 13; 46XX, del (6) – 1), boys – 2 (12,5%). Results. The most common cloacal anomaly was a persistent cloaca – 11 (68,8%), the extrophy of the cloaca was 4 – 25 (25%) and the posterior cloaca – 1 (6,25%) was much less common. Aggravated obstetric history was found in reliable data on the presence of teratogenic factors is associated with a lack of information on obstetric history. In 93,8% of cases, cloacal anomalies were combined with other congenital malformations. In 100% (11) of cases the posterior-sagittal anorectovaginourethroplasty was performed in its various modifications, including LAPassisted – 3 (27,3%). When evaluating long-term results, it was revealed that 3 (27,3%) patients developed chronic recurrent pyelonephritis, 2 (18,2%) had urinary incontinence and first-degree anal incontinence, 1 (9,1%) had sphincter-detrusor insufficiency and anal incontinence of 3 degrees. Conclusion. According to the authors, the issues of surgical strategy for the correction of cloacal anomalies remain unresolved. The morphology of blemish, the spectrum of concomitant pathology are important in the choice. The results of treatment in favorable cases should be considered quite satisfactory. However, in severe forms, poor functional results occur, which often requires repeated reconstructive interventions and long-term rehabilitation of patients.