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Li Y, Liu P, Wang W, Jia H, Bai Y, Yuan Z, Yang Z. A novel genotype-phenotype between persistent-cloaca-related VACTERL and mutations of 8p23 and 12q23.1. Pediatr Res 2024; 95:1246-1253. [PMID: 38135728 DOI: 10.1038/s41390-023-02928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/02/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023]
Abstract
The mechanism underlying anorectal malformations (ARMs)-related VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, and renal and limb abnormalities) remains unclear. Copy number variation (CNV) contributed to VACTERL pathogenicity. Here, we report a novel CNV in 8p23 and 12q23.1 identified in a case of ARMs-related VACTERL association. This 12-year-old girl presented a cloaca (urethra, vagina, and rectum opening together and sharing a single tube length), an isolated kidney, and a perpetuation of the left superior vena cava at birth. Her intelligence, growth, and development were slightly lower than those of normal children of the same age. Array comparative genomic hybridization revealed a 9.6-Mb deletion in 8p23.1-23.3 and a 0.52-Mb duplication in 12q23.1 in her genome. Furthermore, we reviewed the cases involving CNVs in patients with VACTERL, 8p23 deletion, and 12q23.1 duplication, and our case was the first displaying ARMs-related VACTERL association with CNV in 8p23 and 12q23.1. These findings enriched our understanding between VACTERL association and the mutations of 8p23 deletion and 12q23.1 duplication. IMPACT: This is a novel case of a Chinese girl with anorectal malformations (ARMs)-related VACTERL with an 8p23.1-23.3 deletion and 12q23.1 duplication. Cloaca malformation is presented with novel copy number variation in 8p23.1-23.3 deletion and 12q23.1 duplication.
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Affiliation(s)
- Yue Li
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Peiqi Liu
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Weilin Wang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Huimin Jia
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yuzuo Bai
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Zhengwei Yuan
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Zhonghua Yang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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Lazarte-Rantes C, Chirinos-Gambarini M, Sulca-Cruzado GJ, Ramirez-De la Cruz R, Trigoso V, Cerron-Vela C, De la Torre-Mondragon L. T2-based magnetic resonance genitography in children with complex anorectal malformations: experience at a tertiary pediatric hospital in Latin America. Pediatr Radiol 2024; 54:430-437. [PMID: 38273134 DOI: 10.1007/s00247-023-05849-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024]
Abstract
In children with anorectal malformations (ARMs), it is essential to have a diagnostic imaging method that helps with the evaluation of the internal anatomy. In patients with a persistent cloaca, an ARM variant, in which the measurement of the urethral channel and common channel determines surgical management, there are multiple options for imaging. Magnetic resonance imaging (MRI) is an excellent method for this purpose, from which accurate measurements of channel length can be obtained. Additionally, the use of volumetric/isotropic sequences allows multiplanar reformatting. We present our experience with pelvic MRI and intracavitary non-paramagnetic contrast (MR genitography). This method uses volumetric T2-weighted images and the instillation of saline solution as a contrast agent to distinguish the common channel, length of the urethra, anatomy of the vagina, and presence and location of the rectal fistula. We believe this technique to be particularly useful for those working in settings with limited MRI resources.
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Affiliation(s)
- Claudia Lazarte-Rantes
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru.
| | - Mario Chirinos-Gambarini
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru
| | | | - Raul Ramirez-De la Cruz
- Department of Neonatal and Pediatric Surgery, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
| | - Victor Trigoso
- Department of Neonatal and Pediatric Surgery, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
| | - Carmen Cerron-Vela
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Luis De la Torre-Mondragon
- International Center for Colorectal and Genitourinary Care, Children's Hospital Colorado, Denver, CO, USA
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3
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Vacaru A, Won MM, Raymond SL, Chamberlin JD, Radulescu A. Cloacal Dysgenesis Sequence in a Preterm Neonate. Am J Case Rep 2024; 25:e942203. [PMID: 38412145 PMCID: PMC10910718 DOI: 10.12659/ajcr.942203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/23/2024] [Accepted: 12/18/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Cloaca malformations result from a disproportion of apoptosis, cell growth, and maturation. The range of cloacal malformations is extensive and diverse, with a lack of a straightforward classification system. Cloacal dysgenesis sequence (CDS), also known as urorectal septum malformation sequence, is a rare cloaca variant described as the absence of a perineal orifice. Prenatal magnetic resonance imaging and antenatal ultrasounds may reveal a cloacal malformation; however, many patients are not diagnosed with cloacal malformation until birth. CASE REPORT We present a case of a female neonate delivered by a 23-year-old G2P1T1A0L0 mother who had received comprehensive prenatal care. During pregnancy, bilateral multicystic dysplastic kidneys were identified prenatally, leading to the in utero placement of a vesicoamniotic shunt. The physical exam revealed a distended abdomen with reduced abdominal musculature and laxity, ascites, a vesicoamniotic shunt in place, absent urethra, ambiguous genitalia with no vaginal opening, no perineal opening, and clubfoot. Abdominal radiograph showed findings consistent with significant abdominal ascites. An exploratory laparotomy was performed that included diverting colostomy, mucous fistula creation, tube vaginostomy, removal of the vesicoamniotic shunt, and suprapubic tube placement. The patient recovered well from this operation with no complications. CONCLUSIONS CDS is an uncommon condition in pediatric patients, and although sonographic findings can reveal urinary tract abnormalities, prenatal imaging might not always identify CDS. Our case underscores the uniqueness of the case and the significance of early detection and immediate medical and surgical intervention.
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Affiliation(s)
| | - Mitchell M. Won
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Steven L. Raymond
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
| | - Joshua D. Chamberlin
- Division of Pediatric Urology, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
| | - Andrei Radulescu
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
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4
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de Beaufort CMC, Hooijer IN, Kuijper CF, Arguedas Flores OE, de Jong JR, van den Boogaard E, Dekker JJML, Gorter RR. Anatomical Gynecological Anomalies in Girls Born with Anorectal Malformations: A Retrospective Cohort Study of 128 Patients. J Pediatr Adolesc Gynecol 2024; 37:56-62. [PMID: 37777168 DOI: 10.1016/j.jpag.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/22/2023] [Accepted: 09/15/2023] [Indexed: 10/02/2023]
Abstract
STUDY OBJECTIVE In girls born with an anorectal malformation (ARM), anatomical gynecological anomalies (GA) may be present and might need treatment. Therefore, the aim of this study was to provide an overview of GA in girls born with ARM in our cohort. Additionally, diagnostic timing and methods for GA were assessed. METHODS A retrospective mono-center study was performed from January 2000 to December 2022. All patients assigned female at birth were eligible for inclusion. GA were classified according to ESHRE/ESGE classification. Outcomes were the number of girls with GA with subsequent screening methods, factors associated with GA, and GA requiring treatment. Uni- and multivariable logistic regression analyses were performed to identify the association between baseline characteristics and the presence of GA. RESULTS In total, 128 girls were included, of whom 30 (24.1%) had additional GA, with vaginal anomalies being present most often (n = 17). Fifty-six patients (43.8%) underwent full screening, and this number improved over time (37.7% before 2018 vs 72.7% after 2018; P = .003). Thirteen of 30 patients (43.3%) required surgical treatment for their GA, without the occurrence of postoperative complications. CONCLUSION Additional GA were present in almost a quarter of the girls born with an ARM, with vaginal anomalies most often identified. Despite GA being most often found in patients with cloacal malformations, these anomalies were also identified in patients with other ARM types. Surgical treatment was required in almost half of the girls with GA. Therefore, this study emphasizes the importance of screening for GA in patients with an ARM, regardless of the ARM type.
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Affiliation(s)
- Cunera M C de Beaufort
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Surgery, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
| | - Isabelle N Hooijer
- Amsterdam UMC, location University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Caroline F Kuijper
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Urology, Amsterdam, the Netherlands
| | - Olga E Arguedas Flores
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Urology, Amsterdam, the Netherlands
| | - Justin R de Jong
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Surgery, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Emmy van den Boogaard
- Amsterdam UMC, location University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Judith J M L Dekker
- Amsterdam UMC, location University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Ramon R Gorter
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Surgery, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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Yu LX, McGowan M, Bendle K, Mullins C, Streich-Tilles T, Breech LL. Sexual and Reproductive Health Concerns in Adults With Cloacal Anomalies: A Qualitative Study. J Pediatr Surg 2023; 58:2300-2307. [PMID: 37690871 DOI: 10.1016/j.jpedsurg.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/15/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
STUDY OBJECTIVE Long-term gynecologic data are lacking to inform the care of patients with cloacal malformations. We seek to examine perceived sexual and reproductive health challenges of patients born with cloacal anomalies and characterize the experiences of patients as adults. DESIGN AND SETTING Virtual semi-structured focus groups and single-participant interviews were conducted using an online video platform. Retrospective chart review was performed to abstract available demographics and surgical history. PARTICIPANTS Adult patients were contacted from a database of 143 patients born with cloaca who had been seen at or referred to a tertiary care pediatric colorectal center. Participants were recruited until data collection reached thematic saturation. Twenty patients aged 18-53 years participated in 5 focus groups and 3 single-participant interviews. The hospital IRB determined the research activities to be exempt from IRB review and oversight. INTERVENTIONS AND MAIN OUTCOME MEASURES Interviews and focus groups were transcribed and analyzed using the constant comparative method to identify themes regarding sexual and reproductive health and compared with medical and surgical history abstracted from chart review. RESULTS Participants reported many perceived barriers to intercourse and intimacy including bowel and bladder continence management. All participants reported discussion of pregnancy and fertility with healthcare providers as important. Other common themes included concerns about independence and transitioning from pediatric to adult providers. CONCLUSION Anorectal malformations are associated with sexual and reproductive health concerns. Patients seek guidance on family building, intimacy, and transition to adult care. Future quantitative study of these topics is needed to develop best practices for counseling and clinical management of these patients. LEVEL OF EVIDENCE Level VI. TYPE OF STUDY Prognosis Study.
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Affiliation(s)
- Lissa X Yu
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Michelle McGowan
- Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA; Department of Women's, Gender, and Sexuality Studies, University of Cincinnati, Cincinnati, OH, USA
| | - Kara Bendle
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Tara Streich-Tilles
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lesley L Breech
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Abdelmaksoud S, Lobo S, Cho A, Upasani A, Blackburn S, Curry J, Davies B, Martin R, De Win G, Cherian A. Fetal ascites in cloacal malformations-a red flag. Pediatr Surg Int 2023; 39:293. [PMID: 37971531 DOI: 10.1007/s00383-023-05564-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Cloacal malformation is a rare anomaly that remains a diagnostic challenge prenatally, despite the current advances in ultrasonography and MRI. This condition can in some, present with isolated ascites or with other findings, such as a pelvic cyst or upper urinary tract dilatation. In a minority, the ascites may be progressive, questioning the role of antenatal intervention. METHODS We report on ten patients that have been identified from our Cloaca database between 2010 and 2022. RESULTS The presence of ascites was associated with extensive bowel adhesions and matting, leading to a challenging initial laparotomy and peri-operative course. CONCLUSIONS Antenatal finding of ascites in newborns with cloacal malformations should raise a red flag. The surgeon and anaesthetist should be prepared for the operative difficulties secondary to bowel adhesions and the higher risk of haemodynamic instability at the initial surgery. An experienced team at initial laparotomy in such patients is vital. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Sherif Abdelmaksoud
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sara Lobo
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Alexander Cho
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anand Upasani
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Simon Blackburn
- Department of Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Joe Curry
- Department of Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Brian Davies
- Department of Paediatric Surgery, Nottingham Childrens Hospital, Nottingham, UK
| | - Ruppert Martin
- Department of Urology & Paediatric Surgery, University Hospital, Antwerp, Belgium
| | - Gunter De Win
- Department of Urology & Paediatric Surgery, University Hospital, Antwerp, Belgium
| | - Abraham Cherian
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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Pellegrino C, Agamennone M, Iacobelli BD, Turchi B, Capitanucci ML, Beati F, Forlini V, Sollini ML, Marras CE, Esposito G, Palma P, Bella GD, D'Urzo R, Caldaro T, Castelli E, Conforti A, Bagolan P, Mosiello G. Long-term urological outcome of cloaca patients with multidisciplinary management. Pediatr Surg Int 2023; 39:247. [PMID: 37584865 DOI: 10.1007/s00383-023-05539-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Urological management of Cloacal Malformation (CM) focuses on preserving renal function and continence. Study aim was to analyze urinary and intestinal outcomes in CM patients, considering the length of common channel (CC) and presence of occult spinal dysraphism (OSD). METHODS Retrospective review of CM treated at our institution by a multidisciplinary team from 1999 to 2020. Patients with follow-up < 2.5 years were excluded. Length of CC, renal function, urinary and bowel outcomes, presence of associated anomalies (especially OSD) were evaluated. RESULTS Twenty patients were included, median age at follow-up: 8 years (4-15). A long CC > 3 cm was described in 11 (55%). Chronic kidney disease was found in 3 patients. Urinary continence was achieved in 8/20 patients, dryness (with intermittent catheterization) in 9/20. Fecal continence was obtained in 3/20, cleanliness in 14 (under bowel regimen). OSD was present in 10 patients (higher prevalence in long-CC, 73%). Among OSD, 1 patient reached fecal continence, 7 were clean; 2 achieved urinary continence, while 6 were dry. CONCLUSIONS Length of CC and OSD may affect urinary and fecal continence. An early counseling can improve outcome at long-term follow-up. Multidisciplinary management with patient centralization in high grade institutions is recommended to achieve better results.
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Affiliation(s)
- C Pellegrino
- Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy
| | - M Agamennone
- Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy
- Pediatric Surgery, University of Genoa, DINOGMI, Largo Paolo Daneo 3, 16132, Genoa, GE, Italy
| | - B D Iacobelli
- Neonatal Surgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy.
| | - B Turchi
- Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy
- Urology Unit, Azienda Ospedaliera Sant'Andrea, 'Sapienza' University of Rome, Via di Grottarossa, 1035/1039, 00189, Rome, RM, Italy
| | - M L Capitanucci
- Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy
| | - F Beati
- Neonatal Surgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy
| | - V Forlini
- Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy
- Pediatric Surgery, University of Genoa, DINOGMI, Largo Paolo Daneo 3, 16132, Genoa, GE, Italy
| | - M L Sollini
- Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy
- Division of Physical Rehabilitation, University of Tor Vergata, Via Cracovia 50, 00133, Rome, RM, Italy
| | - C E Marras
- Neurosurgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy
| | - G Esposito
- Neurosurgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy
| | - P Palma
- Neurosurgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy
| | - G Della Bella
- Neurorehabilitation and Adapted Physical Activity Day Hospital, Bambino Gesù Children's Hospital IRCCS, 00165, Rome, Italy
| | - R D'Urzo
- Neurorehabilitation and Adapted Physical Activity Day Hospital, Bambino Gesù Children's Hospital IRCCS, 00165, Rome, Italy
| | - T Caldaro
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, RM, Italy
| | - E Castelli
- Neurorehabilitation Unit, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - A Conforti
- Neonatal Surgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy
| | - P Bagolan
- Neonatal Surgery Unit, Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - G Mosiello
- Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy
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Pathak M, Saxena AK. Laparoscopic management of common cloaca: Current status. J Pediatr Urol 2022; 18:142-149. [PMID: 35101384 DOI: 10.1016/j.jpurol.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 12/15/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022]
Abstract
AIM This study reviewed the literature on the laparoscopic management of cloaca. METHODS A Medline and Embase search was performed for "laparoscopy" and "cloaca." Articles for which full-text in English was not available, duplicate articles, and review articles were excluded. Demographic characteristics, duration of follow-up, length of common channel, postoperative complications, and functional outcomes were analyzed. RESULTS The database search retrieved 81 articles after excluding unrelated articles and identified new articles through cross-referencing 14 articles (72 patients) for this review. The rectal pouch was situated below the pubococcygeal (PC) line in three patients. In all other patients, the rectum was located above the PC line. Only the rectal component of the malformation was repaired laparoscopically in 80% (58/72). Fourteen patients underwent laparoscopic mobilization of the rectum and urogenital component. The length of the common channel was more than 3 cm in all these fourteen patients. The most common complication was rectal prolapse (n = 11). Functional evaluation by Krickenbeck scoring system was reported in 32 patients, of which 6/32 (18.75%) had fecal soiling > Grade 2. DISCUSSION Until recently, laparoscopy for the common cloaca was almost exclusively used in patients with low urogenital sinus with high rectal pouch. Moreover, only the rectal component was repaired laparoscopically. Recently, laparoscopic rectal mobilization and urogenital separation was described for patients with common channel length ≥3 cm. It has been reported that laparoscopic vaginal mobilization is easy and more complete by this technique and may avoid vaginal replacement in most of these patients with the long common channel. However, only two studies have reported this technique, and its reproducibility and long-term results are still awaited. Another interesting observation was the increasing use of urethral length along with common channel length in determining the appropriate procedure for the patients with common cloaca. Recent studies propose that the urogenital separation technique be preferred over urogenital mobilization in patients with the short urethra. Nonetheless, we still don't have long-term comparative data to demonstrate that the functional outcomes are better with this new algorithm. We conclude that the persistent cloaca needs an individualized approach, and laparoscopy can be utilized to mobilize the high rectum and is also helpful for the urogenital separation in patients with common channel length >3 cm. However, at present, there is no conclusive evidence to support that laparoscopic repair has a better functional outcome than the open approach.
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Affiliation(s)
- Manish Pathak
- Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Jodhpur, India.
| | - Amulya K Saxena
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Fdn Trust, Imperial College London, London, United Kingdom
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Abstract
RATIONALE Cloacal malformation (CM) is a serious type of anorectal and urogenital tract malformation. However, prenatal ultrasound (US) detection of CM is challenging. In this paper, we reported a rare case of CM prenatally diagnosed by US and magnetic resonance imaging (MRI), as well as reviewed the prenatal US and MRI characteristics of CM in the literature. PATIENT CONCERNS A 30-year-old pregnant woman complained of cystic mass in the fetal abdomen detected by prenatal US. DIAGNOSIS Fetus CM. INTERVENTIONS The fetus was diagnosed as fetal CM by US and MRI, then the pregnant woman received a drug-induced labor treatment. After the neonate was delivered, the measurement was performed on the weight, length, head circumference, abdomen circumference, and bilateral thigh circumference. OUTCOMES A female dead neonate was delivered from the vagina of the gravida, showing congenital anus absence. Prenatal ultrasound demonstrated right kidney duplication, hydronephrosis, and right ureteral dilatation. Meanwhile, prenatal MRI showed a cystic cavity, double collecting systems of right kidney, right ureteral dilatation, and right rectum dilatation. In addition, general parameters are as follows: weight: 2280 g; length: 39 cm; head circumference: 26.3 cm; abdomen circumference: 31 cm; right thigh circumference: 17 cm, and left thigh circumference: 18 cm. LESSONS US combined with MRI can not only provide reliable evidence for fetal CM in the third trimester but also offer crucial information to the pregnant women to establish clinic treatment programs as early as possible.
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Affiliation(s)
| | | | | | - Shu-Yan Liu
- Department of Gynaecology, the Second Hospital of Jilin University, Changchun, Jilin Province, China
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10
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Rehfuss A, Bourgeois T, Thompson B, Sebastião YV, Wood RJ, Jayanthi VR, Fuchs ME. Baseline Renal Volumes in Children Born With Cloacal Anomalies. Urology 2020; 148:250-253. [PMID: 32827534 DOI: 10.1016/j.urology.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 07/17/2020] [Accepted: 08/09/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To better understand why children born with cloacal anomalies are at a high risk of renal insufficiency, this study aims to determine baseline renal volume in children with cloacal anomalies compared to controls. We hypothesized children with cloacal anomalies would be born with less renal volume. METHODS An IRB approved database of children with cloacal anomalies was reviewed. Controls were female patients with 2-vessel umbilical cord or preauricular tags who underwent screening renal ultrasound. Children were included if they had a renal ultrasound in the first 3 months of life. Cloacal exstrophy, horseshoe and cross-fused ectopic kidneys were excluded. Total and individual kidney volumes were compared between the 2 groups. RESULTS The study cohort consisted of 109 patients, 46 (42.2%) cloaca patients and 63 (57.8%) controls. In unadjusted analyses, average total renal volume for cloaca and control patients was 22.4 cm3 vs 25.5 cm3 respectively (P = .1006), and there was no significant difference when adjusting for age (P = .3915). The estimated difference in renal unit volume between cloaca patients without solitary kidneys and controls was -1.6 cm3 (95%C.I.: -3.6, 0.4; P = .1201), and there was no significant difference when adjusting for age (P = .4725). The age-adjusted difference in renal unit volume between cloaca patients with solitary kidney and controls was 1.8 cm3 (95%CI: -1.1, 4.8; P = .2148). CONCLUSIONS Children with cloacal anomalies have similar baseline renal volumes as children without cloacal anomalies. Therefore, the increased risk of renal insufficiency in this patient population appears to be due to renal injury postnatally.
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Affiliation(s)
- Alexandra Rehfuss
- Department of Urology, Nationwide Children's Hospital, Columbus, OH.
| | - Tran Bourgeois
- Center for Surgical Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Benjamin Thompson
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH
| | - Yuri V Sebastião
- Center for Surgical Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Richard J Wood
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH
| | | | - Molly E Fuchs
- Department of Urology, Nationwide Children's Hospital, Columbus, OH
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11
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Schall K, Parks M, Nemivant S, Hernandez J, Weidler EM. Pelvic pain in patients with complex mullerian anomalies including Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH), obstructed hemi-vagina ipsilateral renal anomaly (OHVIRA), and complex cloaca. Semin Pediatr Surg 2019; 28:150842. [PMID: 31668297 PMCID: PMC6936264 DOI: 10.1016/j.sempedsurg.2019.150842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Caring for patients with congenital pelvic anomalies can be challenging in many ways but one crucial aspect is providing longitudinal into adulthood. Newborns with urinary, intestinal or vaginal obstruction require urgent operations to relieve obstruction followed by multiple reconstructive procedures involving the perineum. Openings are created in the pelvic floor musculature that did not exist in development. Adolescence presents further challenges for these postoperative patients while other diagnoses present for the first time in the peri-pubertal teenage years. Young adults can have new symptoms when they become sexually active and are faced with reproductive decisions. During all of these time periods, optimization of function is of paramount importance and patients who are suffering are not able to participate in school, sports or work. This study evaluates the prevalence of pelvic pain in newborns and adolescents with complex congenital pelvic anomalies, associated factors and possible treatment options.
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Affiliation(s)
- Kathy Schall
- Division of Pediatric Surgery, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ 85016, United States
| | - Melissa Parks
- Division of Pediatric and Adolescent Gynecology, Phoenix Children's Hospital, Phoenix, AZ, United States
| | | | - Janett Hernandez
- Division of Pediatric Surgery, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ 85016, United States
| | - Erica M Weidler
- Division of Pediatric Surgery, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ 85016, United States.
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12
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Abstract
PURPOSE The association of gynecological anomalies in all anorectal malformations (ARM) is firmly established. Our goal is to study this pathology in our patients to focus attention to this important issue. METHODS Retrospective study of female patients operated for ARM and who underwent magnetic resonance imaging in our center. The type of malformation, the presence and type of vaginal, uterine, tubaric and urological anomalies were studied. RESULTS 63 patients were included: 34.9% cloaca, 28.6% vestibular and 12.7% perineal. Half of patients had some type of müllerian anomaly; 19 vaginal, most frequent being the longitudinal vaginal septum (66.7%); 30 had uterine alterations, most frequent being the uterus didelphys (60%). Eighty percent of patients with complex ARM (cloaca, exstrophy) presented some type of gynecological malformation compared to 21.8% found in simple ARM (stenosis, perineal, vestibular) (p < 0.001). Vaginal anomalies are associated with a uterine anomaly in 100% of cases. Conversely, patients with uterine anomalies have concurrent vaginal anomaly in 63.3% of cases. CONCLUSION Screening for gynecological anomalies is indicated in all patients with ARM. We recommend a vaginal examination in any girl with ARM during definitive repair and a subsequent MRI during follow-up. Collaboration with a gynecologist is essential.
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Affiliation(s)
- María Fanjul
- Pediatric Surgery Department, Gregorio Marañón University Hospital, Madrid, Spain.
| | - Angel Lancharro
- Pediatric Radiology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - Esther Molina
- Pediatric Surgery Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - Julio Cerdá
- Pediatric Surgery Department, Gregorio Marañón University Hospital, Madrid, Spain
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13
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Dannull KA, Browne LP, Meyers MZ. The spectrum of cloacal malformations: how to differentiate each entity prenatally with fetal MRI. Pediatr Radiol 2019; 49:387-398. [PMID: 30547222 DOI: 10.1007/s00247-018-4302-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/21/2018] [Accepted: 10/31/2018] [Indexed: 01/13/2023]
Abstract
The term cloacal malformation is commonly used to describe the classic cloacal malformation where there is a single common urogenital and intestinal channel located at the expected site of the urethra. There is, however, a spectrum of cloacal abnormalities that differ from this classic type and are less well discussed in the radiologic and surgical literature. The aim of this pictorial essay is to familiarize radiologists with the anatomy, appropriate terminology and key prenatal imaging findings that differentiate the six entities that constitute the spectrum of cloacal abnormalities.
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Affiliation(s)
- Kimberly A Dannull
- Department of Diagnostic Radiology, Division of Pediatric Radiology,, Children's Hospital Colorado,, 13123 East 16th Ave., Mailbox B-463,, Aurora, CO, 80045, USA.
- Department of Radiology,, University of Colorado School of Medicine,, Anschutz Medical Campus, Aurora, CO, USA.
| | - Lorna P Browne
- Department of Diagnostic Radiology, Division of Pediatric Radiology,, Children's Hospital Colorado,, 13123 East 16th Ave., Mailbox B-463,, Aurora, CO, 80045, USA
- Department of Radiology,, University of Colorado School of Medicine,, Anschutz Medical Campus, Aurora, CO, USA
| | - Mariana Z Meyers
- Department of Diagnostic Radiology, Division of Pediatric Radiology,, Children's Hospital Colorado,, 13123 East 16th Ave., Mailbox B-463,, Aurora, CO, 80045, USA
- Department of Radiology,, University of Colorado School of Medicine,, Anschutz Medical Campus, Aurora, CO, USA
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14
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Abdelhalim A, Arab H, Helmy TE, Dawaba ME, Abou-El-Ghar ME, Hafez AT. Cloacal Duplication: Single-center Experience in the Management of a Rare Anomaly. Urology 2017; 108:171-174. [PMID: 28705578 DOI: 10.1016/j.urology.2017.06.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/24/2017] [Accepted: 06/28/2017] [Indexed: 11/19/2022]
Abstract
Cloacal duplication is an exceedingly rare group of anomalies with a limited number of cases reported so far. The anomaly may be confined to partial bladder duplication or it may involve complete duplication of the urogenital tract, hindgut, spine, lower limbs, and vascular structures. Every case is unique and ought to be approached individually. By means of imaging studies and endoscopy, anatomic details should be carefully defined before endorsing surgical correction. A satisfactory outcome can be achieved in the majority of cases. In this report, we describe 3 girls with cloacal duplication, and review pertinent imaging and surgical management.
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Affiliation(s)
- Ahmed Abdelhalim
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Hesham Arab
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Tamer E Helmy
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed E Dawaba
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed E Abou-El-Ghar
- Department of Radiology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ashraf T Hafez
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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15
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Pei Y, Wu Q, Liu Y, Sun L, Zhi W, Zhang P. Prenatal sonographic diagnosis of urorectal septum malformation sequence and chromosomal microarray analysis: A case report and review of the literature. Medicine (Baltimore) 2016; 95:e5326. [PMID: 27828853 PMCID: PMC5106059 DOI: 10.1097/md.0000000000005326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Urorectal septum malformation sequence (URSMS) is a rare congenital abnormal syndrome that is caused by the incomplete division of the cloaca. Based on whether the cloaca membrane breaks down or not, the URSMS are classified as full and partial forms. The prenatal diagnosis of URSMS remains challenging because of poor recognition to this malformation and the relatively non-specific sonographic features. We report a prenatally sonographic diagnosed case of the partial URSMS, and review the literature to summarize the prenatal features. CASE REPORT AND REVIEW A 37-year old woman was referred at 24 weeks of gestation for fetal abdominal cyst. Detailed sonographic examination was done and revealed the vesicocolic fistula, distended colon, absence of perianal hypoechoic ring, pyelectasis, and small stomach bubble. The URSMS was suspected.Amniocentesis was done and karyotyping revealed 46,XY. Furthermore, chromosomal microarray analysis (CMA) was performed for the first time in URSMS and an alteration of 111.8Kb deletion was detected in 16p13.3 which was located inside the RBFOX1 gene. Parental studies showed that the deletion was inherited from the father who has nomal clinical phenotype.The woman elected to terminate the pregnancy at 25 weeks gestation and postmortem examination confirmed the diagnosis of partial URSMS.The published studies were reviewed and 28 cases of URSMS with conducted prenatal ultrasonography were collected in this report. The most common sonographic description, as suspicious signs of URSMS, were severe oligohydramnios or anhydramnios, urinary tract anomalies, fetal intra-abdominal cysts, and dilated bowel. Also, enterolithiasis and vesicocolic fistula were relatively infrequent but highly specific feature of URSMS. CONCLUSIONS URSMS is difficult to be diagnosed prenatally. However, it has characteristic features that can be detected by fetal ultrasonography, and a precise prenatal sonographic examination is crucial for diagnosing URSMS. Besides, more genomic profiling studies are needed to elucidate the causality.
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Affiliation(s)
| | - Qingqing Wu
- Department of Ultrasound
- Correspondence: Qingqing Wu, Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China (e-mail: )
| | | | | | - Wenxue Zhi
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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16
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Ko JS, Gupta AD, Di Carlo HN, Lue K, Gearhart JP. Wire in the hole: a case series of eroded intrapubic wire sutures causing genitourinary complications in the bladder exstrophy complex. Can J Urol 2016; 23:8476-8479. [PMID: 27705734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Bladder exstrophy and cloacal exstrophy are rare congenital defects of the genitourinary tract that require complex surgical reconstruction. Malrotation of the bony pelvis causes a characteristic diastasis of the pubic symphysis, which is surgically reduced at the time of initial bladder closure. For a successful primary closure without tension such that the bladder can be placed deep within the pelvis, pelvic osteotomy is often used. However, alternative techniques have been utilized to bring the pubic rami into apposition. The authors present four bladder/cloacal exstrophy patients in which an intrapubic wire was used for pubic apposition, resulting in significant genitourinary complications.
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Affiliation(s)
- Joan S Ko
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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17
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Abstract
Cloacal anomalies occur when failure of the urogenital septum to separate the cloacal membrane results in the urethra, vagina, rectum and anus opening into a single common channel. The reported incidence is 1:50,000 live births. Short-term paediatric outcomes of surgery are well reported and survival into adulthood is now usual, but long-term outcome data are less comprehensive. Chronic renal failure is reported to occur in 50 % of patients with cloacal anomalies, and 26-72 % (dependant on the length of the common channel) of patients experience urinary incontinence in adult life. Defaecation is normal in 53 % of patients, with some managed by methods other than surgery, including medication, washouts, stoma and antegrade continent enema. Gynaecological anomalies are common and can necessitate reconstructive surgery at adolescence for menstrual obstruction. No data are currently available on sexual function and little on the quality of life. Pregnancy is extremely rare and highly risky. Patient care should be provided by a multidisciplinary team with experience in managing these and other related complex congenital malformations. However, there is an urgent need for a well-planned, collaborative multicentre prospective study on the urological, gastrointestinal and gynaecological aspects of this rare group of complex conditions.
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Affiliation(s)
- M. Ashani Fernando
- Department of Urology, University College London Hospitals, 250 Euston Road, London, NW1 2PG UK
| | - Sarah M. Creighton
- Department of Women’s Health, University College London Hospitals, 250 Euston Road, London, NW1 2PG UK
| | - Dan Wood
- Department of Urology, University College London Hospitals, 250 Euston Road, London, NW1 2PG UK
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18
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Speck KE, Arnold MA, Ivancic V, Teitelbaum DH. Cloaca and hydrocolpos: laparoscopic-, cystoscopic- and colposcopic-assisted vaginostomy tube placement. J Pediatr Surg 2014; 49:1867-9. [PMID: 25487503 DOI: 10.1016/j.jpedsurg.2014.08.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 07/30/2014] [Accepted: 08/27/2014] [Indexed: 11/16/2022]
Abstract
Hydrocolpos presenting at birth in a neonate with a cloacal malformation may lead to massive distension, with compression of adjacent structures. At times, the hydrocolpos requires urgent drainage. Additionally, these neonates need a divided colostomy to divert their fecal stream and prevent genitourinary contamination. We present a novel approach by which these two procedures can be performed as a single operation guided by a combination of cystoscopy, colposcopy, and laparoscopy. This provides a minimally invasive technique with excellent outcome and potentially superior visualization of the necessary intra-abdominal structures.
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Affiliation(s)
- K Elizabeth Speck
- Section of Pediatric Surgery, Department of Surgery, University of Michigan
| | - Meghan A Arnold
- Section of Pediatric Surgery, Department of Surgery, University of Michigan
| | - Vesna Ivancic
- Section of Pediatric Urology, Department of Urology, University of Michigan
| | - Daniel H Teitelbaum
- Section of Pediatric Surgery, Department of Surgery, University of Michigan.
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19
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Boujoual M, Madani H, Benhaddou H, Belahcen M. [Conjoined twins at common omphalocele and cloacal exstrophy with sexual ambiguity]. Pan Afr Med J 2014; 17:243. [PMID: 25170387 PMCID: PMC4145272 DOI: 10.11604/pamj.2014.17.243.2418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 10/07/2013] [Indexed: 11/11/2022] Open
Abstract
Les jumeaux conjoints sont considérés comme étant une complication rare et grave des grossesses monozygotes. Le diagnostic anténatal permet de définir avec précision les structures communes, de rechercher une anomalie congénitale associée, d'organiser l´accouchement et la prise en charge néonatale. Nous présentons un cas rare de jumeaux conjoints dont la fusion se situait au niveau d'une omphalocèle commune associée à une extrophie cloacale, ambiguïté sexuelle et pieds bots. Le diagnostic a été méconnu pendant la grossesse, ce qui a engendré une dystocie lors de l'accouchement. L'issue a été fatale malgré une tentative de séparation et des mesures de réanimation. Ce cas illustre la difficulté liée d'une part à la méconnaissance du diagnostic, d'autre part au caractère urgent de la césarienne et de la séparation chirurgicale.
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Affiliation(s)
- Majdouline Boujoual
- Gynécologie Obstétrique, Faculté de Médecine et de Pharmacie Oujda, Université Mohamed I, Maroc
| | - Hamid Madani
- Anesthésie Réanimation, Faculté de Médecine et de Pharmacie Oujda, Université Mohamed I, Maroc
| | - Housain Benhaddou
- Chirurgie Pédiatrique, Faculté de Médecine et de Pharmacie Oujda, Université Mohamed I, Maroc
| | - Mohamed Belahcen
- Chirurgie Pédiatrique, Faculté de Médecine et de Pharmacie Oujda, Université Mohamed I, Maroc
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20
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Yamada K, Kanamori Y, Tanaka H, Fujino A, Watanabe T, Takeda N, Takahashi M, Yamada W, Ishihama H. Congenital prepubic sinus associated with a urachal remnant: report of a case. Surg Today 2012; 43:1330-2. [PMID: 23266752 DOI: 10.1007/s00595-012-0469-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 05/17/2012] [Indexed: 11/26/2022]
Abstract
Congenital prepubic sinus is a rare congenital anomaly situated in the midline of the lower abdomen. We report a case of congenital prepubic sinus, closely associated with a urachal remnant. Preoperative magnetic resonance imaging showed clearly that the sinus tracked the urachus caudally. This finding supports the theory that the anomaly is caused by abnormal remnant tissue originating from the cloacal membrane, which tracks the allantois duct caudally along with fetal longitudinal growth.
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Affiliation(s)
- Koji Yamada
- Division of Surgery, Department of Surgical Subspecialties, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
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21
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Abstract
Cloacal malformation is a rare but important anomaly. Prenatal diagnosis is possible with knowledge of the distinctive imaging features. The purpose of this case series is to illustrate characteristic prenatal sonographic and magnetic resonance imaging features of cloacal malformation using imaging from 6 cases seen at a single academic center to augment published data. The imaging feature common to all cases was a central cystic pelvic mass containing a characteristic fluid-fluid level. Additional anomalies include uterine and vaginal duplication, hydronephrosis, and lumbosacral anomalies. Prenatal magnetic resonance imaging showed the absence of the normal T1-hyperintense meconium-filled rectum in all cases. Prenatal diagnosis may affect immediate neonatal care (eg, immediate drainage of hydrocolpos) with an ultimate improved outcome.
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Affiliation(s)
- Nicole S Winkler
- Department of Radiology, University of Utah, 30 N 1900 E, 1A071, Salt Lake City, UT 84132, USA.
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22
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Sacks MK, Béraud R. Female pseudo-hermaphroditism with cloacal malformation and related anomalies in a dog. Can Vet J 2012; 53:1105-1108. [PMID: 23543931 PMCID: PMC3447317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 7-month-old intact female German shepherd dog was presented with recurrent urinary tract infections and incontinence, ambiguous external genitalia (enlarged vulva containing a penis), and an anovestibular fistula. Anatomical structures, histopathology, and karyotyping supported a diagnosis of female pseudo-hermaphrodite, hypothesized to be a result of in utero androgenization with consequential cloacal malformation.
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Affiliation(s)
- Margot K Sacks
- Department of Companion Animals - Small Animal Surgery, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island C1A 4P3, Canada.
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23
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Chen CP, Chang TY, Hsu CY, Liu YP, Tsai FJ, Wu PC, Wang W. Persistent cloaca presenting with a perineal cyst: Prenatal ultrasound and magnetic resonance imaging findings. J Chin Med Assoc 2012; 75:190-3. [PMID: 22541150 DOI: 10.1016/j.jcma.2012.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 05/23/2011] [Indexed: 11/25/2022] Open
Abstract
A 40-year-old, primigravid woman presented at 23 weeks of gestation for evaluation of an extra-abdominal echogenic cystic mass of the fetus. Amniocentesis revealed a karyotype of 46,XX. Prenatal ultrasound showed a two-vessel umbilical cord, hydrocolpos, and distended bladder, urethra, and colon, and a perineal cystic mass. The kidneys and amniotic fluid amount were normal. Fetal magnetic resonance imaging revealed ascites, hydrocolpos, distended urinary bladder and colon, high rectum, and a perineal cyst. The fetus postnatally manifested persistent cloaca. The perineum was distended and smooth, without patent anal, vaginal, and urethral openings. The external genitalia were ambiguous with no labia majora, labia minora, or clitoris. The perineal cyst had a very small single orifice. We suggest that cloacal anomalies be considered in any female fetus with hydrocolpos, distended bladder and colon, ascites, and a perineal cyst.
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, ROC.
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24
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Goyal A, Fishwick J, Hurrell R, Cervellione RM, Dickson AP. Antenatal diagnosis of bladder/cloacal exstrophy: challenges and possible solutions. J Pediatr Urol 2012; 8:140-4. [PMID: 21641871 DOI: 10.1016/j.jpurol.2011.05.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/10/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify the pitfalls in accurate antenatal diagnosis of bladder exstrophy (BE) and cloacal exstrophy (CE), and thus understand the challenges for antenatal counselling. METHODS A prospectively maintained bladder exstrophy database of antenatal and live born referrals for BE/CE was used to identify patients. Data were collected about the antenatal scan findings and the outcome of pregnancy. RESULTS Between 2003 and 2009, 40 new babies with BE/CE were referred and of them 10 had an antenatal diagnosis. Five patients did not have a diagnosis despite suspicious findings noted on antenatal scans and another three had a wrong diagnosis of BE/CE. Of the 16 referrals with antenatal suspicion of BE/CE, 5 opted for termination. At the 20-week scan, it was possible to identify the gender of the fetus in 3/16 cases only. CONCLUSIONS Only a quarter of the babies born with BE/CE had received an antenatal diagnosis. Raising awareness about the condition amongst radiographers, and facilitating further scanning by a specialist fetal management unit if suspicious findings are noted, is crucial for improving the rate of detection. An antenatal diagnosis may not be reliable, and difficulty in identifying gender at the 20-week scan adds to the complexity of antenatal counselling. Magnetic resonance imaging and karyotyping may provide additional helpful information.
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Affiliation(s)
- Anju Goyal
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK.
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25
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Livingston JC, Elicevik M, Breech L, Crombleholme TM, Peña A, Levitt MA. Persistent cloaca: a 10-year review of prenatal diagnosis. J Ultrasound Med 2012; 31:403-407. [PMID: 22368130 DOI: 10.7863/jum.2012.31.3.403] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The purpose of this study was to review antenatal sonographic findings in children born with persistent cloaca. METHODS Infants (n =145) with persistent cloaca followed at a center for colorectal congenital anomalies were identified by a retrospective chart review. Fifty female infants with a persistent cloaca met inclusion criteria and had prenatal records and imaging studies available for review. Sonographic data were retrospectively abstracted from charts. RESULTS Anomalies were detected in 27 of 50 cases (54%). A correct antenatal diagnosis of persistent cloaca occurred in 3 of 50 (6%). Common findings misinterpreted on antenatal sonography include urinary tract anomalies, dilated bowel, and a cystic pelvic mass (representing hydrocolpos). CONCLUSIONS Antenatal diagnosis of persistent cloaca is difficult. Persistent cloaca should be considered in the differential diagnosis if urinary tract malformations, dilated bowel loops, or cystic pelvic masses are visualized by prenatal diagnosis.
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Affiliation(s)
- Jeffrey C Livingston
- Department of Obstetrics and Gynecology, East Carolina University, Brody School of Medicine, Greenville, North Carolina 27834, USA.
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Witters I, Meylaerts L, Peeters H, Coumans A, Wirjosoekarto S, Fryns JP. Fetal hydrometrocolpos, uterus didelphys with low vaginal and anal atresia: difficulties in differentiation from a complex cloacal malformation: a case report. Genet Couns 2012; 23:513-517. [PMID: 23431753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Hydrometrocolpos, occurring in approximately 1/6000 newborn girls, can be caused by a stenotic urogenital sinus, a severe cloacal malformation, but also by other conditions such as an imperforate hymen, a midline vaginal septum and vaginal atresia. The prenatal differential diagnosis of this wide spectrum of conditions is not easy and requires a multidisciplinary approach with follow-up scans and MRI to access the severity of the condition. A non-consanguineous couple was referred in the first pregnancy at 30 weeks. The father, 30 years of age, of Kaukasian origin, and the mother of Asian origin, 26 years of age. Ultrasound at 30 weeks revealed ambiguous genitalia (with suspicion of clitoral hypertrophy), a septated structure located behind the bladder compatible with hydrometrocolpos with a uterine malformation (uterus didelphys), a single umbilical artery, mild ascites and growth on the tenth centile. The differential diagnosis included a vaginal atresia, a urogenital sinus and a more severe cloacal malformation. After serial scans, MRI and counselling by an experienced surgeon the preferential diagnosis of a cloacal malformation was made and a late pregnancy termination was performed. Pathological examination revealed: low vaginal atresia with uterus didelphys, anal atresia with rectovaginal fistula and a normal urinary tractus. The differential diagnosis between hydrometrocolpos due to vaginal atresia or due to a more severe cloacal malformation is not straightforward. Care should be taken in decision making and counselling patients with these complex prenatal malformations.
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Affiliation(s)
- I Witters
- Center for Human Genetics, Catholic University of Leuven, Leuven, Belgium.
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Abstract
Cloacal dysgenesis sequence (CDS) is a rare and lethal malformation. We report such a case of long-term survival, currently to 12 years of age. In the fetal period, she received a timely placement of vesico-amniotic shunt for a megabladder due to a severe urethral obstruction. Postnatally, cystostomy and colostomy were created because of no perineal opening of urethra, vagina, and anus. Anorectoplasty, construction of efferent conduit, and colostomy closure were performed at 4 years of age. Ileovaginoplasty and ileovesicostomy which was a Mitrofanoff-type of conduit, and labioplasty were performed at the age of 11 years. To the best of our knowledge, only five survivors with CDS over 1 year of age have been reported.
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Affiliation(s)
- Toshihiro Yanai
- Department of Pediatric Surgery, Ibaraki Children's Hospital, 3-3-1 Futabadai, Mito-city, Ibaraki, 311-4145, Japan.
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Yilmaz O, Genc A, Ayhan S, Ozcan T, Aygoren R, Taneli C. A female patient with congenital pouch colon (CPC): a case report. Acta Chir Belg 2011; 111:335-337. [PMID: 22191141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Congenital short colon, more commonly known as pouch colon, is a rare anomaly that can be encountered with anorectal malformations (ARM). The colon is shorter than normal and the distal end is dilated like a pouch. We report the case of a newborn with a Type 2 pouch colon. A female newborn was brought to our clinic with a diagnosis of cloaca anomaly. Her physical examination revealed a single canal introitus and flat perineum. In the abdominal x-ray taken in the upright position, a prominent air sac was noticed at the left side. A laparotomy was performed and exploration demonstrated that the colon was like a pouch. The pouch terminated in the upper part of the vagina with a wide canal. A genitogram displayed the presence of double uteri and double vaginas. One month after the operation we performed a cystoscopy, which showed the urethral meatus to be more proximal than normal (female type hypospadias). When the patient was 8 months old she was re-operated and anterior-abdomino-posterior sagittal anorectoplasty plus tube coloplasty were performed. She is now 4 years old and has a stool discharge of 2-3 times a day. Her physical and psychosocial development is in concordance with her age. Congenital pouch colon is a very rare anomaly, which has to be considered especially during the clinical evaluation of children with cloacal malformations and high type anorectal anomalies.
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Affiliation(s)
- O Yilmaz
- Department of Paediatric Surgery, Celal Bayar University, Medical Faculty, Manisa, Turkey.
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Calvo-Garcia MA, Kline-Fath BM, Levitt MA, Lim FY, Linam LE, Patel MN, Kraus S, Crombleholme TM, Peña A. Fetal MRI clues to diagnose cloacal malformations. Pediatr Radiol 2011; 41:1117-28. [PMID: 21409544 DOI: 10.1007/s00247-011-2020-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 12/29/2010] [Accepted: 02/07/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prenatal US detection of cloacal malformations is challenging and rarely confirms this diagnosis. OBJECTIVE To define the prenatal MRI findings in cloacal malformations. MATERIALS AND METHODS We performed a retrospective study of patients with cloacal malformations who had pre- and post-natal assessment at our institution. Fetal MRI was obtained in six singleton pregnancies between 26 and 32 weeks of gestation. Imaging analysis was focused on the distal bowel, the urinary system and the genital tract and compared with postnatal clinical, radiological and surgical diagnoses. RESULTS The distal bowel was dilated and did not extend below the bladder in five fetuses. They had a long common cloacal channel (3.5-6 cm) and a rectum located over the bladder base. Only one fetus with a posterior cloacal variant had a normal rectum. Three fetuses had increased T2 signal in the bowel and two increased T1/decreased T2 signal bladder content. All had renal anomalies, four had abnormal bladders and two had hydrocolpos. CONCLUSION Assessment of the anorectal signal and pelvic anatomy during the third trimester helps to detect cloacal malformations in the fetus. The specificity for this diagnosis was highly increased when bowel fluid or bladder meconium content was identified.
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Affiliation(s)
- Maria A Calvo-Garcia
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
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De Vos C, Arnold M, Sidler D, Moore SW. A comparison of laparoscopic-assisted (LAARP) and posterior sagittal (PSARP) anorectoplasty in the outcome of intermediate and high anorectal malformations. S AFR J SURG 2011; 49:39-43. [PMID: 21933483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 12/22/2010] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Laparoscopic-assisted ano-rectoplasty (LAARP) has gained popularity since its introduction in 2000. Further evidence is needed to compare its outcome with the gold standard of posterior sagittal ano-rectoplasty (PSARP). METHOD A retrospective review of patients presenting with ano-rectal malformation (ARM) in the period 2000 - 2009. Demographics, associated abnormalities, and operative and post-operative complications were assessed. The functional outcome in children older than 3 years was assessed, applying the Krickenbeck scoring system and, where possible, by interviewing parents. Patients with cloacal abnormalities were excluded. Patients with a LAARP were compared with those managed by PSARP. RESULTS Seventy-three patients with ARM were identified during the study period. Male to female ratio was 1.6:1. All 32 low ARMs (perineal and vestibular fistulae) were excluded. Thirty-nine had levator or supra-levator lesions. Twenty males presented with recto-bulbar, 3 with recto-prostatic, and 1 with a recto-vesical fistula; 2 had no fistula; and in 2 the data were insufficient to determine the level. Among the females, 6 had recto-vaginal fistulae, 4 had cloacas and 1 had an ARM without fistula. There were 3 syndromic ARMs (2 Trisomy 21 and 1 Baller-Gerald syndrome). One neonate with a long-gap oesophageal atresia had a successful primary LAARP. Seventy-five per cent of all patients had VACTERL associations. Two early deaths after colostomy formation were related to a cardiac anomaly and an oesophageal atresia. In both groups, mean age at anoplasty was 8 months. Twenty of the intermediate/high lesions were treated with LAARP, and 19 by PSARP. There were slightly more complications in the LAARP group; intra-operative injury to the vas deferens and urethra occurred once each. Post-operatively, 2 port-site hernias and 1 case of pelvic sepsis occurred. A poorly sited colostomy caused difficulty in 2 patients. Two patients were converted to laparatomy: severe adhesions in one and a poorly sited stoma in another. Five patients required redo-anoplasty for mucosal prolapse, anal stenosis, incorrect placement of the anus, retraction of the rectum and an ischaemic rectal stricture. Complications in the PSARP group included 2 wound dehiscences, 1 anal stenosis, 3 mucosal prolapses, 1 recurrent fistula and 2 incorrect anal placements requiring redo surgery. The Krickenbeck questionnaire was used in 70% of PSARPs (mean age 5.9 years) and LAARPs (mean age 5.5 years) for a functional assessment. Both groups showed voluntary bowel movements in 14%. Soiling and overflow incontinence was a significant problem. Grade III constipation was less common in the LAARP (14%) than PSARP (21%) group. Four patients in the LAARP group were reliant on regular rectal washouts compared, with 6 in the PSARP group. CONCLUSION Both LAARP and PSARP can successfully treat ARM but have specific associated problems.
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Affiliation(s)
- C De Vos
- Division of Paediatrics Surgery, Stellenbosch University, Tugersberg, W Cape
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Braga LHP, Whelan K, DeMaria J, Pippi-Salle JL. Newborn with persistent cloaca presenting with accessory phallic urethra and ambiguous genitalia. Urology 2011; 78:680-3. [PMID: 21334047 DOI: 10.1016/j.urology.2010.12.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 12/28/2010] [Accepted: 12/29/2010] [Indexed: 11/17/2022]
Abstract
Persistent cloaca is a rare urogenital anomaly that can pose significant challenges for adequate diagnosis and management. We describe the case of an infant girl with a cloacal malformation, having a single perineal orifice and an accessory phallic urethra, who presented with ambiguous genitalia at birth. The distal part of the accessory phallic urethra was used to create a mucosa-lined vestibule as a part of the total urogenital sinus mobilization. This technical maneuver allowed a more natural looking, and possibly functioning, vaginal introitus, improving the final cosmetic result.
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Affiliation(s)
- Luis H P Braga
- Division of Pediatric Urology, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
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Arnone K, Cloutier J, Bolduc S. Persistent cloaca and partial caudal duplication: a case report. Urology 2011; 78:431-3. [PMID: 21296396 DOI: 10.1016/j.urology.2010.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/05/2010] [Accepted: 11/05/2010] [Indexed: 11/17/2022]
Abstract
Persistent cloaca and caudal duplication are 2 rare anomalies of embryogenesis that can present with a wide variety of pelvic malformations. Here we present the rare case of a female born with both abnormalities. The infant was born with a single introitus, an imperforate anus, a didelphys uterus, a duplicated cervix and vagina, and accessory limb and coccyx. Multiple surgeries were performed to correct for the anomalies that would have otherwise had important health and lifestyle consequences for the child.
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Affiliation(s)
- Krystina Arnone
- Division of Urology, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec, Canada
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Varygin V, Bernotas Š, Gurskas P, Karmanovas V, Strupas S, Zimanaitė O, Verkauskas G. Cloacal exstrophy: a case report and literature review. Medicina (Kaunas) 2011; 47:682-685. [PMID: 22370468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cloacal exstrophy is an extremely rare congenital malformation resulting in an exstrophy of the urinary, intestinal, and genital organs and associated with anomalies of other organ systems. We present a complicated case of cloacal exstrophy and the recent progress in the management of this probably most complicated anomaly in pediatric urology and surgery.
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Affiliation(s)
- Vitalij Varygin
- Department of Gastroenterology, Nephrourology and Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Abstract
INTRODUCTION Prenatal diagnosis of anorectal malformations currently occurs in 0-15.9% of screened cases. In cloacas, these numbers are unknown. We speculate that some images from prenatal ultrasound studies may suggest the diagnosis of cloaca, but are not recognized because of a lack of suspicion for this diagnosis. METHODS A retrospective review of the medical records of 489 patients born with cloaca was performed; 95 of them had prenatal ultrasound reports that represent the material analyzed for this study. A literature review was performed, finding 31 publications, with 68 cloaca patients detected by prenatal images. The abnormal findings of our patients were compared with those described in the literature to determine the most common abnormal prenatal images found in patients with cloaca. RESULTS The 95 ultrasound reports found in our patients described 270 abnormalities, the most frequent were: abdominal/pelvic cystic/mass (39), hydronephrosis (36), oligohydramnios (23), distended bowel/bowel obstruction (19), ascites (15), 2 vessel cord (14), dilated bladder (14), dilated ureter (14), polyhydramnios (10), echogenic bowel (8), multicystic kidney (8), "ambiguous genitalia" (7), hydrops fetalis (7), hydrocolpos (4), absent kidney (3), abnormal spine (3), and anorectal atresia (3). In spite of these findings, the radiologists who interpreted the studies only suspected a cloaca in 6 cases (6%). The literature review showed 212 abnormalities in 68 demonstrated cloaca patients. The most frequent were: abdominal/pelvic cystic/mass (46), hydronephrosis (44), ascites (21), oligohydramnios (20), distended bowel (11), multicystic dysplastic kidney (7), ambiguous genitalia (6), non-visualization of the bladder (6), two-vessel cord (5), dilated bladder (5), intraabdominal calcification (4), polyhydramnios (4), enterolithiasis (4), hydrometrocolpos (3), and dilated ureter (3). CONCLUSION We conclude that it is possible to suspect the diagnosis of cloaca, prenatally, more frequently than what currently occurs, looking at the same images but with an increased index of suspicion for cystic abdominal masses and a combination of gastrointestinal and urological abnormalities.
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Affiliation(s)
- Andrea Bischoff
- Colorectal Center for Children, Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229, USA.
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Abstract
OBJECTIVE To provide a comprehensive overview of the clinical features, diagnosis, current management strategies, and outcomes of cloacal exstrophy. METHODS A PUBMED/Medline search of the literature was performed on cloacal exstrophy focusing on associated anomalies, treatment, and quality of life issues. RESULTS The incidence of cloacal exstrophy is between 1 in 200,000 and 400,000 live births. Survival rates now approach 100% secondary to improved understanding of underlying abnormalities and advances in neonatal care and surgical technique. Important principles of initial management include proper nutritional support, early closure of exstrophy, and preservation of intestinal length. The achievement of urinary and fecal continence remains a challenge. Data for long-term outcomes are now emerging which provide new insight into issues of gender identity, function, and psychosocial development of these patients. CONCLUSION Cloacal exstrophy remains a rare and complex congenital anomaly, characterized by an array of anatomical defects affecting multiple organ systems. A multidisciplinary approach to management is advocated with a focus on optimization of patient function and quality of life.
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Affiliation(s)
- Lynn L Woo
- Division of Pediatric Urology, Monroe Carell Jr. Vanderbilt Children's Hospital, Nashville, TN 37232, USA.
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Mukhtar RA, Baskin LS, Stock PG, Lee H. Long-term survival and renal transplantation in a monozygotic twin with cloacal dysgenesis sequence. J Pediatr Surg 2009; 44:e31-3. [PMID: 20006002 DOI: 10.1016/j.jpedsurg.2009.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 09/24/2009] [Accepted: 09/25/2009] [Indexed: 11/19/2022]
Abstract
Cloacal dysgenesis sequence (CDS) is a severe hindgut malformation occurring in 1:50,000 to 250,000 live births (Qureshi et al. Prenatal diagnosis of cloacal dysgenesis sequence: differential diagnosis from other forms of fetal obstructive uropathy. Fetal Diagn Ther 1998;13:69-74; Bargaje et al. Cloacal dysgenesis sequence. Ann Diagn Pathol 2008;12:62-66). It is characterized by a smooth perineum with no urethral, vaginal, or anal openings, and lack of labioscrotal development. Typically, the bladder, vagina, and colon each end blindly, although persistent cloaca without perineal orifice can be seen. With no egress for urine, infants have renal insufficiency and pulmonary hypoplasia, usually making CDS lethal (Sahinoglu Z et al. The prenatal diagnosis of cloacal dysgenesis in six cases: can the termination of pregnancy always be the first choice? Prenat Diagn 2004;24:10-16). Reported survivors have had a persistent urachus or have been spared the effects of oligohydramnios by the presence of a twin (Liang X. Cloacal dysgenesis sequence: observations in four patients, including three fetuses of second trimester gestation. Pediatr Dev Pathol 1998;1:281-288). We report a case of long-term survival, currently to 25 months of age, and renal transplantation in a monochorionic, diamniotic twin girl with CDS.
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Affiliation(s)
- Rita A Mukhtar
- Department of Surgery, University of California, San Francisco, CA 94143, USA.
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Ono K, Kikuchi A, Takagi K, Takahashi D, Yoshizawa K, Nishizawa S. Prenatal sonographic features of complete covered cloacal exstrophy. Ultrasound Obstet Gynecol 2009; 34:481-482. [PMID: 19790101 DOI: 10.1002/uog.7346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Borg H, Holmdahl G, Olsson I, Wiklund LM, Sillén U. Impact of spinal cord malformation on bladder function in children with anorectal malformations. J Pediatr Surg 2009; 44:1778-85. [PMID: 19735825 DOI: 10.1016/j.jpedsurg.2009.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 03/02/2009] [Accepted: 03/02/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE Risk factors for the presence of neurogenic bladder dysfunction (NBD) in children born with high anorectal malformations (ARMs), were investigated, to identify the need for urodynamics in these patients. MATERIAL AND METHODS The study included 37 patients with high ARMs (21 boys and 16 girls). Bladder function was evaluated with urodynamics both before and after anorectoplasty (posterior sagittal anorectoplasty [PSARP]). All patients were investigated with spinal radiograph. Spinal ultrasound was performed in the neonatal period, and magnetic resonance imaging was added in case of abnormal ultrasound or urodynamics and in case of cloacal malformation. RESULTS In ARM patients with rectourethral and vestibular fistulas and cloacas, NBD was identified in 9 children (25%). The bladder dysfunction was innate in all cases except in one girl with cloaca, indicating that the risk of iatrogenic denervation seems minimal using the PSARP technique. All children with innate NBD had a spinal cord malformation either as spinal cord regression or tethering with or without a lipoma. Concerning vertebral status, almost all children with NBD had partial sacral agenesis. Abnormal perineal appearance was highly correlated to NBD in boys, especially in those with a spinal cord regression malformation. Innate NBD was not found in any child with normal spinal cord. CONCLUSION From these results, we suggest that spinal ultrasound and perineal inspection are used as screening procedures for NBD in children with ARM. Urodynamic investigation is recommended only when spinal cord anomalies or other signs indicative of NBD are present. In case of spinal cord malformation, repeated urodynamics during follow-up is mandatory because of the risk for developing tethered cord syndrome.
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Affiliation(s)
- Helena Borg
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at University of Gothenburg, 416 85 Gothenburg, Sweden.
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Ciftçi AO, Soyer T, Tanyel FC. A previously unreported variant of exstrophy cloaca. Turk J Pediatr 2008; 50:609-612. [PMID: 19227431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Cloacal exstrophy, a rare and complex congenital anomaly, presents with omphalocele; exstrophied bilateral hemibladders with ureteric or miillerian remnant orifices; central exstrophied ileocecal bowel plate with superior orifice of the terminal ileum, inferiorly, the colon, and centrally, the appendix; bifid rudimentary external genitalia; separated pubic rami; low-set umbilicus; and epispadias in the classic form. A newborn case of cloacal exstrophy presenting without an exstrophied intestine and vesicointestinal fistula is reported. The clinicopathologic features of this previously unreported variant of cloacal exstrophy are discussed with special emphasis on embryologic basis. Exstrophied bowel is the main component of exstrophy cloaca, which makes our case unique with regard to the absence of exstrophied bowel and vesicointestinal fistula. This well-known fact is not applicable to the present case. We think that some other unknown mechanisms must be at work for the development of the cloacal exstrophic anomaly presenting with a shortened intact colon ending with an anteriorly located anus. Normal development of the hindgut primarily depends on the normal formation of the cloacal membrane. The basic morphogenetic processes that consist of cell deposition, fusion, and merging should achieve the precise balance between cell proliferation and apoptotic cell death both in hindgut and cloacal membrane development. Unsatisfactory explanations of many similar malformations are primarily due to the lack of accurate and illustrative findings in different fields of embryology. The present case confirms that further studies are required to clarify the various theories in order to achieve more satisfactory explanations for these types of rare anomalies.
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Affiliation(s)
- Arbay O Ciftçi
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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40
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41
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Karnak I, Sanlialp I, Ekinci S, Senocak ME. Minimally conjoined omphalopagi: emphasis on embryogenesis and possibility of emergency separation. Turk J Pediatr 2008; 50:503-508. [PMID: 19102061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Minimally conjoined omphalopagus twins (MCOTs) has been recognized in the last decade as a special subgroup in which omphalopagus twins have union of peritoneal cavities through anterior lower abdominal wall defect with union of distal small intestine and patent urachal structures and associating anorectal malformation. A careful review of the current literature revealed that MCOTs have usually been separated in emergency situations within the first hours of life due to ruptured omphalocele, gastroschisis, stillbirth of one of the twins, intestinal obstruction, or requirement of enterostomy for cloacal anomaly. Pediatric surgeons should be familiar with MCOTs and ready for emergency separation with thorough knowledge of the anatomical relationships of the connecting structures and the embryologic basis for this anomaly. We present a new set of MCOTs separated in emergency conditions with a review of the relevant English literature. We give special emphasis to the common surgical characteristics and a brief discussion on the embryogenesis of this rare condition.
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Affiliation(s)
- Ibrahim Karnak
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Thomas JC, DeMarco RT, Pope JC, Adams MC, Brock JW. First Stage Approximation of the Exstrophic Bladder in Patients With Cloacal Exstrophy—Should This be the Initial Surgical Approach in all Patients? J Urol 2007; 178:1632-5; discussion 1635-6. [PMID: 17707035 DOI: 10.1016/j.juro.2007.03.164] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Indexed: 11/15/2022]
Abstract
PURPOSE Cloacal exstrophy is rare and it represents a reconstructive challenge. Options for managing the urinary tract include primary closure or approximation of the bladder halves in the midline with later closure. We present our observations and evolving thoughts concerning optimal treatment in these patients. MATERIALS AND METHODS We retrospectively reviewed the records of patients with cloacal exstrophy seen in the last 5 years. Initial management was examined, including complete primary closure vs a staged approach. We noted midline defects, spinal cord abnormalities or other anatomical reasons that precluded primary closure. RESULTS Seven patients, including 5 females and 2 males, were identified. An omphalocele noted in all 7 patients was closed in 5 at initial operation. All underwent preservation of the hindgut in the fecal stream. Spinal cord tethering was noted in 7 of 7 cases. Complete primary bladder closure was performed in 3 of the 7 patients, while the size of the bladder plates or a large abdominal wall defect precluded closure in the remainder. Continence was not achieved in the 3 cases closed primarily. All patients achieving urinary continence underwent bladder neck closure and augmentation cystoplasty with a continent catheterizable channel. CONCLUSIONS Patients with cloacal exstrophy have anatomical issues that can prevent complete primary bladder closure or preclude the achievement of urinary continence. The high incidence of tethered cord places these patients at risk for upper tract changes and bladder decompensation during followup. Despite successful primary closure in 3 of 7 patients all have a tiny bladder and require secondary procedures to become continent. Extensive dissection during the first operation can contribute to more difficult dissection with potential increased morbidity during subsequent surgeries. Therefore, the best initial approach for the typical patient may be closure of the abdominal wall and approximation of the exstrophied bladder halves in the midline. Secondary closure with continent diversion and reconstruction of the external genitalia can be performed at ages 18 to 24 months.
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Affiliation(s)
- J C Thomas
- Division of Pediatric Urology, Monroe Carrell Jr. Vanderbilt Children's Hospital, Nashville, Tennessee 37232-9820, USA.
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Abstract
We report a case of vaginal reconstruction using a flap from urinary bladder in a young girl. This girl was born with cloacal malformation and hemivaginas connected to the urinary bladder. Repeated urinary tract infection and vesicoureteral reflux were noted. At the age of 9 months, she received posterior sagittal anorectoplasty for rectum pull-through, but the urogenital part was not corrected. She had repeated urinary tract infection. Detrusor areflexia and large bladder volume were demonstrated by cystometry. Cystoscopy showed a common channel longer than 3 cm. Urogenital reconstruction was performed at 14 months of age. A part of the urinary bladder wall, which was connected to the vaginas, was used to lengthen the vagina so that the latter was able to pull down to the perineum. The patient received vaginal dilatation and intermittent catheterization after the surgery.
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Affiliation(s)
- Taiwai Chin
- Pediatric Surgery, Taipei Veterans General Hospital, National Yangming University, Taipei 11217, Taiwan.
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Baughman SM, Richardson RR, Podberesky DJ, Dalrymple NC, Yerkes EB. 3-Dimensional magnetic resonance genitography: a different look at cloacal malformations. J Urol 2007; 178:1675-8; discussion 1678-9. [PMID: 17707025 DOI: 10.1016/j.juro.2007.03.196] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Indexed: 10/22/2022]
Abstract
PURPOSE Standard contrast genitography and endoscopy have been the cornerstone of preoperative investigation of anatomy in complex cloacal malformations. In many cases standard genitography is ambiguous and lengthy endoscopy may be required to define the anatomy. Nonenhanced magnetic resonance imaging lacks definition of the nondistended common channel and confluence. To our knowledge we introduce 3-dimensional magnetic resonance genitography for delineating the unique anatomical features of these complex anomalies. MATERIALS AND METHODS Contrast genitography, endoscopy and 3-dimensional magnetic resonance genitography were performed preoperatively in 4 female infants with cloacal malformations. Three-dimensional magnetic resonance genitography was performed using a 3-dimensional spoiled gradient technique after the instillation of gadolinium-diethylenetetramine pentaacetic acid solution via the common channel and cutaneous vesicostomy, when present. Augmented pressure distal colostogram with gadolinium via the mucous fistula was included. Three-dimensional images were constructed using a commercially available workstation. RESULTS Three-dimensional magnetic resonance genitography yielded anatomical information far superior to that of standard genitography in all cases and it provided information on female genital tract anomalies and hindgut confluence that were not fully appreciated at initial endoscopy. The confluence was most accurately represented by augmented pressure colostogram. The length of the common channel was consistent with that on endoscopy. Rotating 3-dimensional images illustrated the unique anatomical relationships. No magnetic resonance imaging specific complications were observed. CONCLUSIONS Three-dimensional magnetic resonance genitography provides superior anatomical detail for the preoperative assessment of cloacal malformations. It augments the information obtained by standard magnetic resonance imaging of the pelvic organs, levators and lumbosacral spine. Three-dimensional magnetic resonance genitography has great potential as a standard for preoperative anatomical evaluation and it will likely simplify preoperative endoscopy rather than supplant it.
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Affiliation(s)
- Steven M Baughman
- Department of Urology, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, Texas, USA
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Mukherjee B, McCauley E, Hanford RB, Aalsma M, Anderson AM. Psychopathology, Psychosocial, Gender and Cognitive Outcomes in Patients With Cloacal Exstrophy. J Urol 2007; 178:630-5; discussion 634-5. [PMID: 17570426 DOI: 10.1016/j.juro.2007.03.144] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE Psychological functioning, as reflected in psychopathology, psychosocial functioning, gender identity, gender role and cognitive abilities, was examined in a sample of patients with cloacal exstrophy. MATERIALS AND METHODS Nine participants 11 to 37 years old completed the evaluation. Standardized measures were used and participant responses were compared to the norms of the various instruments. Gender reassigned participants with cloacal exstrophy were compared with nonassigned participants with cloacal exstrophy. Mean differences between the 2 groups were calculated using the t test. RESULTS Overall the participants with cloacal exstrophy reported good psychological functioning. Significant differences between reassigned and nonassigned participants were found in the area of depression. All participants had a stable gender identity. XY females showed more male-typical gender roles. There were no significant group differences on cognitive assessments. Reassigned and nonassigned participants did not differ in IQ. CONCLUSIONS Although being born with cloacal exstrophy puts patients at risk for psychopathology and psychosocial problems, it does not necessarily mean that these problems will develop. With the appropriate support these patients can have remarkably well adjusted lives.
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Affiliation(s)
- Bipasha Mukherjee
- University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
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Picone O, Laperelle J, Sonigo P, Levaillant JM, Frydman R, Senat MV. Fetal magnetic resonance imaging in the antenatal diagnosis and management of hydrocolpos. Ultrasound Obstet Gynecol 2007; 30:105-9. [PMID: 17588226 DOI: 10.1002/uog.4062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Hydrocolpos should be considered systematically when an abdominopelvic cystic mass is diagnosed in a female fetus. Because the prognosis and neonatal management of isolated hydrocolpos with spontaneous resolution differs greatly from that of hydrocolpos associated with a cloacal malformation, it is important to ascertain prenatally whether there are associated anomalies. We report the prenatal characteristics of three fetuses with hydrocolpos; in two cases there was spontaneous resolution and one infant was born with digestive tract atresia. The principal ultrasound findings were an oblong anechoic pelvic mass with or without a sagittal septum, located behind a normal bladder. On magnetic resonance imaging (MRI), the cervical imprint on the vagina confirmed the diagnosis of hydrocolpos and helped to diagnose cloacal malformation by demonstrating the absence of meconium beside the bladder on T1 sequences. Our cases show that MRI is useful for differentiating isolated hydrocolpos from hydrocolpos associated with cloacal malformation.
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Affiliation(s)
- O Picone
- Institut national de la santé et de la recherche médicale U782, Université Paris Sud, Hôpital Antoine Béclère, Clarmart, France.
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Dhombres F, Jouannic JM, Brodaty G, Bessiere B, Daffos F, Bénifla JL. Contribution of prenatal imaging to the anatomical assessment of fetal hydrocolpos. Ultrasound Obstet Gynecol 2007; 30:101-4. [PMID: 17523129 DOI: 10.1002/uog.3998] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Hydrocolpos may be associated with a lower urinary tract obstruction in a spectrum of urorectal malformations ranging from persistent urogenital sinus to cloacal dysgenesis. As cloacal dysgenesis carries the worst postnatal prognosis, detailed prenatal ultrasound should focus on the fetal pelvic anatomy to provide the parents with appropriate prenatal counseling. We report three cases of fetal hydrocolpos associated with low urinary tract obstructions, including two with a normal appearance of the anal canal and rectum on prenatal ultrasound and one with a complex cloacal malformation which contributed to the precise prenatal assignment of the malformation in each case within the spectrum of urogenital sequence malformations.
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Affiliation(s)
- F Dhombres
- Service de Gynécologie-Obstétrique, Hôpital Rothschild, Paris, France
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Shono T, Taguchi T, Suita S, Nakanami N, Nakano H. Prenatal ultrasonographic and magnetic resonance imaging findings of congenital cloacal anomalies associated with meconium peritonitis. J Pediatr Surg 2007; 42:681-4. [PMID: 17448765 DOI: 10.1016/j.jpedsurg.2006.12.060] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE Cloacal malformations are rare anomalies, occurring in females, and in which they demonstrate a single perineal orifice for urethra, vagina, and rectum. Prenatal ultrasonograms (US) of cloacal malformations sometimes show ascites, hydrocolpos, and hydronephrosis. We herein describe the characteristic prenatal US and magnetic resonance imaging (MRI) findings of the cloacal malformations associated with meconium peritonitis. METHODS The pre- and postnatal records of 11 newborn patients with cloacal malformations, treated in our hospital from 1988 to 2004, were reviewed. All fetuses underwent prenatal US by experienced obstetricians, whereas in addition, fetal MRI was performed in 1 patient. RESULTS The prenatal US and/or MRI findings showed fetal ascites, a multicystic pelvic mass, oligohydramnios, and bilateral hydronephrosis in 5 of 11 patients with cloacal malformations. In these 5 cases, postnatal examinations showed associated hydrocolpos, hydrometrocolpos, and bilateral hydronephrosis; furthermore, 4 of these 5 cases also showed meconium peritonitis at laparotomy. CONCLUSIONS The prenatal US and MRI findings, showing fetal ascites, multicystic pelvic mass, bilateral hydronephrosis, and oligohydraminios are highly suggestive of the cloacal malformations associated with meconium peritonitis.
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Affiliation(s)
- Takeshi Shono
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
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Abstract
PURPOSE Total urogenital mobilization is deemed to preserve the urogenital sinus blood supply and avoid ischemic complications. We report our experience with this technique for cloacal repair. MATERIALS AND METHODS We retrospectively reviewed all consecutive cases of persistent cloaca managed by total urogenital mobilization via a posterior sagittal approach by a single pediatric urologist between 1998 and 2003. During this period 22 girls (12 with a common channel longer than 3 cm) underwent total urogenital mobilization for cloaca repair (1 redo) at a median age of 10 months (range 2 to 102). A total of 15 procedures (68%) could be completed by a perineal approach only. Four patients with a long common channel required additional maneuvers after mobilization to complete the reconstruction. RESULTS Urethral stenosis was observed in 2 patients after urethral separation from the vagina (1) and common channel retubularization (1). One child with a perineal hemangioma required a redo posterior sagittal anorectoplasty for complete vaginal and anal closure. In addition, 1 case of urethrovaginal fistula was diagnosed on cystovaginoscopy but was asymptomatic, and 1 child with a minor residual common channel underwent urethral revision to allow easier intermittent catheterization. With a median followup of 48 months (range 11 to 162) the latest examination involving endoscopy with anesthesia showed a good result in 17 patients, a tight introitus that might require further surgery in 3 and a minimal residual common channel of 0.5 cm in 2. CONCLUSIONS Total urogenital mobilization is an effective technique for repairing short and long common channels, and a low surgical complication rate can be anticipated.
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Affiliation(s)
- Marc-David Leclair
- Pediatric Urology and Pediatric Surgery Departments, Great Ormond Street Hospital for Children, London, United Kingdom.
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Abstract
Cloacal exstrophy is a complex congenital anomaly that affects both the gastrointestinal and genitourinary systems. It is characterized by an omphalocele, an exstrophied bladder, abnormal genitalia, and imperforate anus. Prior to 1960, there were no reported cases of survival, but because of advancements in neonatology, surgery, and anesthesiology, the survival rate has improved drastically. This case presentation of an infant born with cloacal exstrophy includes discussion of etiology, diagnosis, treatment, ethical issues, and nursing care.
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MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/etiology
- Abnormalities, Multiple/therapy
- Anus, Imperforate/diagnosis
- Anus, Imperforate/etiology
- Anus, Imperforate/therapy
- Bladder Exstrophy/diagnosis
- Bladder Exstrophy/etiology
- Bladder Exstrophy/therapy
- Cloaca/abnormalities
- Cloaca/embryology
- Clubfoot/diagnosis
- Clubfoot/etiology
- Clubfoot/therapy
- Hernia, Umbilical/diagnosis
- Hernia, Umbilical/etiology
- Hernia, Umbilical/therapy
- Humans
- Infant, Newborn
- Information Services
- Intensive Care, Neonatal
- Internet
- Male
- Meningomyelocele/diagnosis
- Meningomyelocele/etiology
- Meningomyelocele/therapy
- Neonatal Nursing
- Nurse's Role
- Parents/education
- Parents/psychology
- Penis/abnormalities
- Perioperative Care
- Prenatal Diagnosis
- Quality of Life
- Rare Diseases
- Social Support
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