Total Urogenital Mobilization
Total Urogenital Mobilization
Surgical Stages of
Total Urogenital Mobilization: 
End of the Procedure
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A few years back, the next step was to separate the vagina from the urinary tract, dissect and pull the vagina down, leaving the old common channel as a neo-urethra and place the vagina immediately behind the it.
More recently, a new more valuable maneuver has been incorporated as part of the surgical treatment of short cloacae which is called "total urogenital mobilization."
This maneuver consists in the mobilization of both vagina and urethra together as a unit.
After the rectum has been separated and mobilized, multiple silk stitches are placed taking the edge of the vagina and the common channel, in order to apply uniform traction on the urogenital sinus to be mobilized.
Another series of stitches are placed across the urogenital sinus approximately five milimeters approximal to the clitoris. The urogenital sinus is totally transected between the last row of silk stitches and the clitoris.
The urogenital sinus is dissected using the natural plan existing between it and the pubis.
While applying traction to the multiple stitches, the suspensory ligaments of the urethra and bladder-neck (which are fibrous avascular bands) are divided which immediately provides a significant mobilization of the entire urogenital sinus.
With this relatively simple maneuver, one can gain between two to three centimeters of length.
Probably, in over 50 percent of all cloaca this mobilization is enough to create a good urethral opening and vaginal opening without having to separate the vagina from the urethra which used to be the main source of morbidity (mainly urethro-vaginal fistulas).
This total urogenital mobilization provides an excellent blood supply of both urethra and vagina and places the urethral opening in a visible location which facilities intermittent catheterization when necessary. It also provides a smooth urethra which can be catheterized easily.
In a significant number of cases, this maneuver is not enough to create a good vaginal opening and further mobilization of the vagina is necessary.
For this group of patients, the old previous maneuver of separation of vagina from the urethra still has to be performed.
The advantage, now, is separation is done in an easier way because the total urogenital mobilization allows that separation of vagina to be done outside the wound.
For more information or to request an appointment, please contact the Colorectal Center at Cincinnati Children's.
