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=Abstract=

Repair of Cloacal Anomaly Using

"Total Urogenital Mobilization Method of Pefia"

Jae-Hee Jung, M.D., Young-Tack Song, M.D.

Department of Surgery, St. Mary' s Hospital, the Catholic University of Korea Seoul, Korea

Persistent cloaca in a female newborn is one of the most complex and challenging anorectal malformation. The

incidence

is

about

10% of all anorectal anomalies. Treatment of

cloacal

malformations has

evolved

during the past 40 years. However, it still remains one of

the

most difficult operations.

In 1997,

Pena reported a new procedure

called "Total

urogenital mobilization"

.

We have repaired 3 cases of cloacal anomaly using

"Total urogenital mobilization" . The

operations were performed between age 15 and 28 months. The length of the common channels was 2.5 -

3.0 cm. Two cases had double vaginas and one of

them also had double uterus. The operation time was 4-5 hours and no major complications occurred. Functional and

cosmetic

results were satisfactory.

Index Words

: Cloaca, Anorectal malformation, Total urof(enital mobilization

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Fig. 1. Surgical photograph (case 1) after separation of the recturn(R) from the urogenital sinus(U).

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Fig. 2. Surgical view (case 2) of the urogenital sinus, with multiple silk sutures placed at the double vaginal edges (V) after the rectum (R) has been separated. Another series of sutures (black arrow) are placed across the urogenital sinus very close to the clitoris(C). The urogenital sinus is going to be mobilized from the pubic bone anterior to these sutures. The catheter is inserted into the bladder.

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Fig. 3. The perineum after complete reconstruction (case 3). U; new urethral opening, V; new vaginal opening, A; new anus.

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Fig. 4. Preoperative MRI (midsagittal view), showing confluence and the common channe1(arrows) of bladder, vagina, rectum (case 1).

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Fig. 6. Preoperative MRl (coronal view), showing confluence of double vaginas (white arrows) and rectum (black arrow) (case 3).

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1. Pena A: The surgical management of persistent cloaca: Results in 54 patients treated with a posterior sagittal approach. J Pediatr Surg 24:590-598, 1989

2. Pena A: Total Urogenital Mobilization-An Easier Way to Repair cloacas. J Pediatr Surg 32:263-268, 1997

3. Kay R, Tank ES: Principles of management of the persistent cloaca in the female newborn. J Urol 117:102-104, 1977

4. Hendren WH: Cloaca, the most severe degree of imperforate anus: experience with 195 cases.

Ann Surg 228:331-346, 1998

5. Raffensperger JG, Ramenofsky ML: The management of a cloaca. J Pediatr Surg 8:647- 657, 1973

6. Zaccara A, Gatti C, Silveri M, Rivosecchl M, Bilancioni E, Spina V, Giorlandino C, de Gennaro M, Bagolan P: Persistent cloaca: Are

we ready for a correct prenatal diagnosis?

Urology 54:367, 1999

7. Gough MH: Anorectal agenesis with persist-

ence of cloaca. Proc Roy Soc Med 52:886-

889, 1959, cited from Pena A: Total Uroge- nital Mobilization-An Easier Way to Repair cloacas. J Pediatr Surg 32:263-268, 1997 8. Pena A, Devries PA: Posterior sagittal anor-

ectoplasty: Important technical considerations and new applications. J Pediatr Surg 17:

796-811, 1982

9. Hendren WH: Surgical management of urogenital sinus abnormalities. J Pediatr Surg 12:

339-357, 1977

10. Hendren WH: Urogenital sinus and anorectal malformation: Experience with 22 cases. J Pediatr Surg 15:628-641, 1980

11. Hendren WH: Further experience in recon- structive surgery for cloacal anomalies. J Pediatr Surg 17:695-717, 1982

12. Hendren WH: Repair of cloacal anomalies:

Current Techniques. J Pediatr Surg 21: 1159-- 1176,1986

13. Ludwikowski B, Hayward 10, Gonzalez R:

Total urogenital sinus mobilization: expanded applications. BJU Int 83:820-822, 1999