SURGICAL RECONSTRUCTION OF CLOACAL MALFORMATION CAN ALTER BLADDER FUNCTION: A COMPARATIVE STUDY WITH ANORECTAL ANOMALIES

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Abstract
Patients with cloacal anomalies often suffer bladder dysfunction with recurrent urinary infections and incontinence. We examined the effect of surgical reconstruction by posterior sagittal approach and total urogenital mobilization in either causing or worsening bladder dysfunction. Between August 2000 and December 2002 all new patients with cloacal anomalies were prospectively studied to assess the effect of surgical reconstruction by posterior sagittal approach and total urogenital mobilization on bladder function. A comparable group of patients with anorectal malformation (ARM) were studied as comparative controls to assess the effect of posterior sagittal approach without urogenital surgery. Structural anatomy was defined by radiology. Natural filling urodynamics via suprapubic catheter were performed in all infants at 0.2 to 9 months (mean 3) before surgical reconstruction. This assessment was repeated 6 to 24 months (mean 14.8) after surgery, and changes in bladder function were determined by comparative statistics. A total of 10 patients with cloacal anomalies (5 with short [less than 3 cm] and 5 with long common channel [greater than 3 cm]) and 20 patients with anorectal malformation were consecutively studied. At presentation bladder dysfunction was present in 9 of 10 patients with cloacal anomalies and in 12 of 20 patients with ARM. After surgery there was significant deterioration in bladder function in half of the cloacal group (5 of 10 patients, p = 0.04) and in 1 of 20 patients with ARM (p = 0.7). Of the 5 patients with cloacal anomalies who had deterioration of bladder function urodynamic pattern of detrusor overactivity changed to inadequate (atonic) bladder in 4, all of whom had a long common channel at presentation. Patients with cloacal malformation have a high incidence of innate bladder dysfunction. However, surgical reconstruction by total urogenital mobilization can cause further deterioration of bladder function, particularly in the group with a long common channel. Urodynamic assessment is necessary to detect bladder dysfunction in these patients.