Principles of Management of the Persistent Cloaca in the Female Newborn

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Abstract
The persistent cloaca in the female newborn is one of the more complex and challenging developmental malformations that the pediatric urologist encounters. A review of 5 patients and 34 completely documented cases was undertaken to characterize the defects and devise a logical diagnostic and therapeutic approach. Diagnostic steps included the search for associated anomalies, which were present in the upper urinary tract (33%), gastrointestinal tract (13%), cardiovascular system (13%), CNS (10%) and respiratory tract (5%). Delineation of the cloaca and its anatomic relationships was determined by abdominal X-rays, injection of contrast material into the cloacal channel, excretory urography and endoscopy with selective catherterization. Surgical treatment began with a diverting right transverse colostomy in the newborn period followed by rectal pull-through when the patient weighed 25 lb. Vaginal pull-through was performed at the same time as the rectal pull-through when the vagina entered the cloaca high. If the cloacovaginal communication was low, a vaginoplasty by a posterior flap procedure was done when the child was 10-12 yr old. Even if anatomy was reconstructed in an ideal manner urinary and fecal continence could not be assured since congenital neurologic dysfunction was not uncommon.

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