Achieving Full Anatomical Correction in Girls with cloacal anomalies: A Necessity or an Overdoing?

Purpose: To highlight a different concept for the urogenitoplasty in the management of cloaca and its possible implications on functional and cosmetic outcome.
Patients and Methods: The study included six cases of cloaca who were recently managed during the period 2011 through 2015. Regarding urogenitoplasty, two cases with low urogenital confluence had a short common channel and were managed by introitoplasty in one and partial urogenital sinus mobilization in the other. One case with high distended vagina communicating close to the bladder neck was managed by vaginal pull-through, while keeping the common urogenital sinus to act as urethra. In between, three intermediate cases were also managed by introitoplasty, while keeping them with the common urogenital sinus uncorrected.
Results: The follow-up period ranged from 2 to 6.5 years. Apart from the hypoplastic external genitalia, all cases included in the study had minimal perineal scaring compared with old cases that underwent extensive perineal ‘urogenital’ dissection. Urinary and stool incontinence was observed in one case that was associated with caudal regression syndrome. Another case that underwent vaginal pull-through had poor evacuation of the urinary bladder; this was managed by anticholinergics and clean intermittent catheterization. The rest of cases had voluntary bowel movements and spontaneous voluntary micturition.
Conclusion: Considering the potential risk and complications of separating the vagina from the urethra in some cases of cloaca, it might be better from the functional and cosmetic point of view to perform just introitoplasty while keeping these girls with the common urogenital sinus uncorrected.