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Prenatal urinary ascites and persistent cloaca: risk factors for poor drainage of urine or meconium
M C Adams1, J Ludlow, J W Brock
1Vanderbilt Children's Hospital, Vanderbilt University, Nashville, Tennessee, USA.
Insights
Persistent cloaca in girls can cause abnormal urine and meconium drainage, potentially diagnosed prenatally. Cutaneous vesicostomy effectively diverted urine in infants before definitive repair.
Area of Science:
- Pediatric Surgery
- Urology
- Neonatal Medicine
Background:
- Persistent cloaca is a complex congenital anomaly.
- It involves the fusion of the urinary, genital, and gastrointestinal tracts.
- Aberrant drainage can occur due to the unique anatomical confluence.
Observation:
- Three female patients with persistent cloaca presented with urinary ascites.
- This ascites resulted from intraperitoneal urine reflux via the genital system.
- A long, narrow cloaca with high confluence of urethra, vagina, and rectum was noted.
Findings:
- Cutaneous vesicostomy was performed in all three patients.
- This procedure effectively diverted urine away from the cloaca.
- The intervention was performed prior to definitive surgical repair.
Implications:
- Persistent cloaca can lead to significant urinary outflow resistance.
- High confluence in persistent cloaca may cause aberrant urine and meconium drainage.
- Prenatal identification of these issues suggests a need for postnatal intervention.
Purpose:
The unique confluence of the urinary, genital and gastrointestinal tracts in girls with persistent cloaca potentially results in aberrant drainage of urine and meconium that may be characteristic, allowing a prenatal diagnosis to be made.
Materials And Methods:
Three of our last 15 patients with cloacal anomalies presented with urinary ascites due to intraperitoneal reflux through the genital system. In 3 female patients a long, narrow cloaca was associated with a high confluence of the urethra, vagina and rectum. All 3 patients ultimately underwent creation of a cutaneous vesicostomy.
Results:
In all 3 cases cutaneous vesicostomy effectively diverted urine away from the cloaca before definitive repair.
Conclusions:
The urethra-like persistent cloaca may result in significant outflow resistance. When combined with high confluence, it may cause aberrant drainage of urine and/or meconium. When such problems are noted prenatally, they are likely to persist postnatally and require intervention.