PURPOSE: Total urogenital mobilization has achieved widespread use because it avoids surgical complications of vaginal reconstruction. We used urodynamic studies to assess bladder function and urological outcomes after definitive repair by total urogenital mobilization. MATERIALS AND METHODS: We identified 27 girls diagnosed with persistent cloaca between 1991 and 2008. We retrospectively reviewed the records of 11 patients (median age 14 months) who underwent reconstruction of the cloaca by total urogenital mobilization. Urinary continence was assessed in 7 patients older than 4 years. Urodynamic studies were performed postoperatively in 7 patients. Median followup was 72 months. RESULTS: Rate of surgical complications was 9%. Urinary continence was achieved in 6 patients (86%), while 1 patient (14%) remained incontinent. Of the continent patients 3 (43%) voided spontaneously and 3 (43%) required clean intermittent catheterization. Urodynamic studies showed detrusor underactivity or acontractile detrusor in all patients during the voiding phase. Bladder compliance was normal in 6 patients (86%) and poor in 1 (14%). Detrusor overactivity was seen in 5 patients (71%) but resolved on followup in 2 (40%). Rate of continence was higher in the absence of detrusor overactivity (1 of 1 patient vs 2 of 3 with detrusor overactivity). CONCLUSIONS: Most patients with persistent cloaca can achieve urinary continence after total urogenital mobilization. Two-thirds of patients display bladder dysfunction after the procedure. Detrusor overactivity can resolve with development of the bladder but persistent detrusor overactivity might delay the achievement of mechanisms of urinary continence.
PURPOSE: Total urogenital mobilization has achieved widespread use because it avoids surgical complications of vaginal reconstruction. We used urodynamic studies to assess bladder function and urological outcomes after definitive repair by total urogenital mobilization. MATERIALS AND METHODS: We identified 27 girls diagnosed with persistent cloaca between 1991 and 2008. We retrospectively reviewed the records of 11 patients (median age 14 months) who underwent reconstruction of the cloaca by total urogenital mobilization. Urinary continence was assessed in 7 patients older than 4 years. Urodynamic studies were performed postoperatively in 7 patients. Median followup was 72 months. RESULTS: Rate of surgical complications was 9%. Urinary continence was achieved in 6 patients (86%), while 1 patient (14%) remained incontinent. Of the continent patients 3 (43%) voided spontaneously and 3 (43%) required clean intermittent catheterization. Urodynamic studies showed detrusor underactivity or acontractile detrusor in all patients during the voiding phase. Bladder compliance was normal in 6 patients (86%) and poor in 1 (14%). Detrusor overactivity was seen in 5 patients (71%) but resolved on followup in 2 (40%). Rate of continence was higher in the absence of detrusor overactivity (1 of 1 patient vs 2 of 3 with detrusor overactivity). CONCLUSIONS: Most patients with persistent cloaca can achieve urinary continence after total urogenital mobilization. Two-thirds of patients display bladder dysfunction after the procedure. Detrusor overactivity can resolve with development of the bladder but persistent detrusor overactivity might delay the achievement of mechanisms of urinary continence.
Authors: Harshjeet Singh Bal; Sudipta Sen; Cenita Sam; Jacob Chacko; John Mathai; S R Regunandan Journal: J Indian Assoc Pediatr Surg Date: 2017 Apr-Jun