Abstract
BackgroundPersistent 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).ResultsRenal 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 casesThe 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%).ConclusionRenal 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 evidenceThis is a case series with no comparison group (level IV).
Highlights
Persistent cloaca or cloacal anomalies represent a special category of anorectal anomalies (ARA) affecting the female sex with a reported incidence of about one in 25,000 live birth [1]
The concept of urogenital sinus mobilization appeared [7] aiming to save operative time and blood loss that may result from a difficult vaginal separation [3]; but still the technique
We stratified cloaca into three types according to the level of urogenital confluence in relation to the pubic symphysis (Fig. 2)
Summary
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. 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). Persistent cloaca or cloacal anomalies represent a special category of anorectal anomalies (ARA) affecting the female sex with a reported incidence of about one in 25,000 live birth [1]. One can find the detailed descriptions and illustrations of Hardy Hendren reporting his surgical experience in the management of a wide spectrum of complex cases of cloaca [4, 5]. The introduction of the posterior sagittal approach gained wide-spread acceptance and increased our understanding about the surgical anatomy of the anal sphincters [6] This has been reflected on improving the outcome of repairing the anorectal component of the anomaly. The concept of urogenital sinus mobilization appeared [7] aiming to save operative time and blood loss that may result from a difficult vaginal separation [3]; but still the technique
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