Title

Factors predicting the need for vaginal replacement at the time of primary reconstruction of a cloacal malformation.

Document Type

Article

Publication Date

1-2020

Identifier

DOI: 10.1016/j.jpedsurg.2019.09.054

Abstract

BACKGROUND: A subset of patients with cloacal malformations requires vaginal replacement during their primary reconstruction, increasing the surgical complexity. Identifying factors which predict the need for vaginal replacement would facilitate operative planning.

METHODS: We retrospectively reviewed patients who underwent primary cloacal reconstruction at our Center (2014-2018) and assessed the length of the common channel, urethra, and vagina. The presence of hydrocolpos at birth, Müllerian anomalies, sacral ratio, and tethered cord were also assessed between patients who did and did not require vaginal replacement.

RESULTS: 50 patients were identified. 17/50 patients (34%) underwent a total urogenital mobilization (TUM), and none required vaginal replacement. 33/50 (66%) patients underwent a urogenital separation. 19/33 (58%) required vaginal replacement. This group had a shorter vagina (4.2 cm vs 6.6 cm, p < 0.01). There was no difference in urethral or common channel length, number of cervices, sacral ratio, presence of a vaginal septum, hydrocolpos, or tethered cord between those who did and those who did not require vaginal replacement.

CONCLUSIONS: Urethral and common channel lengths were used to successfully determine the operative plan (TUM or urogenital separation) to reconstruct cloacal malformations. The need for urogenital separation and a shorter vaginal length were predictive of the need for vaginal replacement.

LEVEL OF EVIDENCE: Level IV.

TYPE OF STUDY: Case series with no comparison groups.

Journal Title

Journal of pediatric surgery

Volume

55

Issue

1

First Page

71

Last Page

74

MeSH Keywords

Cloaca; Female; Humans; Hydrocolpos; Neural Tube Defects; Reconstructive Surgical Procedures; Replantation; Retrospective Studies; Sacrum; Urethra; Urogenital Abnormalities; Uterus; Vagina

Keywords

Cloacal malformation; Total urogenital mobilization (TUM); Urogenital separation; Vaginal replacement

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