Gynaecological concerns in cloaca anomaly: A 20-year single-centre experience

Area of Science:

• Pediatric Surgery
• Gynecology
• Developmental Biology

Background:

• Persistent cloaca is a rare congenital anorectal malformation with limited data on long-term gynecological outcomes.
• This study focuses on the gynecological concerns and outcomes in adolescent patients with cloacal malformations.
• It also evaluates the co-occurrence of renal and Müllerian anomalies.

Purpose of the Study:

• To present the experience with cloacal malformations, emphasizing gynecological aspects.
• To describe a standard assessment and follow-up protocol during puberty.
• To evaluate the association between renal and Müllerian anomalies.

Main Methods:

• A retrospective cohort study was conducted over 20 years (January 2003-September 2023).
• Patients with a confirmed diagnosis of cloacal malformation were included.
• Data were summarized using descriptive statistics.

Main Results:

• Twenty-eight patients were analyzed; 78% had uterine didelphys, and 21% required resection of abnormal Müllerian structures.
• Fourteen percent showed ipsilateral renal and Müllerian anomalies.
• Vaginal complication rates were higher in the urogenital separation group (58%) compared to the posterior sagittal approach group (12%); 28% overall vaginal stricture rate.
• Among 15 pubertal patients, 5 experienced menstrual outflow obstruction, with 3 managed by hormonal suppression.

Conclusions:

• Gynecological outcomes in cloacal malformation are significantly influenced by unobstructed menstrual outflow at menarche.
• Early identification of abnormal Müllerian structures and prompt management of surgical complications are vital.
• Long-term follow-up during puberty is essential for timely diagnosis and management of gynecological issues, with hormonal suppression as a potential interim therapy.