Surgical Management of Persistent Cloaca: Results in 54 Patients Treated With a Posterior Sagittal Approach
Journal of Pediatric Surgery
June 1989 • Volume 24 • Number 6 • p590 to p598
Alberto Peña, MD
Abstract
This report describes the author's personal experience in the surgical treatment of 54 patients with persistent cloaca. The approach is called posterior sagittal ano recto vagino urethroplasty / PSARVUP.
Forty patients underwent a primary procedure, and 14 a secondary operation. The anatomic variations found were multiple, integrating a wide spectrum of defects.
The posterior sagittal approach proved to be a good initial approach, and permitted complete repair of the defect in 47 patients. Seven patients required a laparotomy in addition.
The length of the common channel varied from 0.5 to 7 cm. Common channels longer than 3 cm usually required some technical alternative to replace the vagina.
In at least 34 cases, the vagina was reconstructed primarily without any additional technical manoeuvres. Different degrees of vaginal and uterine septation were found in 25 of 50 cases.
Hydrocolpos was an associated defect in 14 of 49 patients. Sixty-eight percent of the patients had an important associated urological defect.
Twenty-six patients were clinically evaluated without medical management, 21 of whom had voluntary bowel movements by the age of 3 years, but most of them had minor episodes of soiling.
Nineteen patients had a normal sacrum, and five had urinary incontinence that was successfully managed by intermittent catheterization.
Seven patients had a very abnormal sacrum, and five of them had urinary incontinence.
Twenty patients underwent a late postoperative vaginoscopy, 14 of whom showed an adequate introitus and vagina, whereas five had different degrees of narrowing of the introitus.
Six patients had a urethrovaginal fistula. One ureter was accidentally divided and one vagina had complete ischaemic necrosis.
(J Pediatr Surg 1989 Jun;24(6):590-8)
Journal of Pediatric Surgery (Copyright ! 2002 by W.B. Saunders Company)
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