Surgical management of cloacal malformations

Cloaca is defined as a defect in which the urinary tract, the vagina and the rectum are fused, creating a single common channel, and opening into an orifice at the site of the normal urethra. Correct management includes an early diagnosis and adequate treatment from the newborn period. We believe that these patients are frequently misdiagnosed and consequently mistreated. The analysis of our experience with the treatment of 330 cases allowed us to make specific recommendations to improve the management of these patients. During the first 24 h of life, emphasis is placed on the recognition and treatment of potentially lethal associated defects, mainly urologic, oesophageal or cardiac. The baby should not be taken to the operating room without ruling out these associated defects. The basic principles of the main repair are delineated. Patients suffering from cloacas with common channels shorter than 3 cm can be treated by a general paediatric surgeon, provided he or she is familiar with the procedure and observes a delicate and meticulous technique. Patients suffering from cloacas with common channels longer than 3 cm belong, by definition, to a more complex type of deformity that, in order to be repaired, requires a surgeon with more experience as well as knowledge of paediatric urology. Sixty percent of all our patients enjoy voluntary bowel movements (VBM). Seventy percent of all patients with a common channel longer than 3 cm require intermittent catheterization to empty their bladder, whereas 20% of those born with a common channel shorter than 3 cm require such a manoeuvre. All patients must be followed on a long-term basis in order to evaluate sexual function and care for obstetric issues.