Hendt P Versteegh1, Cornelius E J Sloots2, Katja P Wolffenbuttel3, Justin R de Jong4, Christien Sleeboom5, Wout F Feitz6, L W Ernest van Heurn7, David C van der Zee8, Rene M H Wijnen9, Ivo de Blaauw10. 1. Dept. of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands. Electronic address: h.versteegh@erasmusmc.nl. 2. Dept. of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands. Electronic address: c.sloots@erasmusmc.nl. 3. Dept. of Pediatric Urology, Erasmus MC-Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands. Electronic address: k.wolffenbuttel@erasmusmc.nl. 4. Pediatric Surgical Center Amsterdam, Emma Children's Hospital AMC & VU University Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: j.r.dejong@amc.uva.nl. 5. Pediatric Surgical Center Amsterdam, Emma Children's Hospital AMC & VU University Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: chr.sleeboom@vumc.nl. 6. Dept. of Pediatric Urology, Radboud University Medical Center - Amalia Children's Hospital, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: wout.feitz@radboudumc.nl. 7. Dept. of Pediatric Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: e.vanheurn@mumc.nl. 8. Dept. of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands. Electronic address: d.c.vanderzee@umcutrecht.nl. 9. Dept. of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands. Electronic address: r.wijnen@erasmusmc.nl. 10. Dept. of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands; Dept. of Surgery - Pediatric Surgery, Radboud University Medical Center - Amalia Children's Hospital, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: ivo.deblaauw@radboudumc.nl.
Abstract
OBJECTIVE: Current surgical techniques for cloacal reconstruction are posterior sagittal anorecto vagino urethroplasty (PSARVUP) and posterior sagittal anorectoplasty (PSARP) with total urogenital mobilization (TUM). The aim of this study was to explore the results of reconstructive cloaca surgery in the Netherlands and evaluate urogenital function after PSARVUP and TUM. PATIENTS AND METHODS: Medical records from five pediatric surgical departments in the Netherlands were studied for patients with cloacal malformations treated between 1985 and 2009. Forty-two patients were eligible, and patients with short common channels were categorized into PSARVUP and TUM groups. Groups were compared using Fisher's exact test. RESULTS: Median age at time of surgery was 9 months (range 1-121). In 24 patients (57%) a PSARVUP was done, in 18 patients (43%) TUM. Median follow-up was 142 months (range 15-289). At follow-up spontaneous voiding was seen in 29 patients (69%). Clean intermittent catheterization (CIC) was needed in 14 patients (33%); a urinary diversion was created in 10 patients (24%). In total 32 patients (76%) were dry with no involuntary loss of urine per urethra. Recurrent urinary tract infections were seen in 23 patients (55%). When comparing PSARVUP and TUM groups in our series of patients with short common channels, there were no differences in urological outcome. Normal menstruation was present in 11 of the 20 patients who reached puberty (55%). CONCLUSION: Urogenital functional outcome after reconstructive surgery for cloacal malformations was similar in PSARVUP and TUM groups in patients with short common channels. A thorough urological follow-up is needed to establish the long-term bladder function and urinary incontinence results to prevent long-term risks of recurrent UTI. Albeit without differences between PSARVUP and TUM groups, 45% of the patients present with abnormal or absent menstruations. Gynecological follow-up is mandatory in all patients with cloacal malformations 6 months after the first sign of puberty.
OBJECTIVE: Current surgical techniques for cloacal reconstruction are posterior sagittal anorecto vagino urethroplasty (PSARVUP) and posterior sagittal anorectoplasty (PSARP) with total urogenital mobilization (TUM). The aim of this study was to explore the results of reconstructive cloaca surgery in the Netherlands and evaluate urogenital function after PSARVUP and TUM. PATIENTS AND METHODS: Medical records from five pediatric surgical departments in the Netherlands were studied for patients with cloacal malformations treated between 1985 and 2009. Forty-two patients were eligible, and patients with short common channels were categorized into PSARVUP and TUM groups. Groups were compared using Fisher's exact test. RESULTS: Median age at time of surgery was 9 months (range 1-121). In 24 patients (57%) a PSARVUP was done, in 18 patients (43%) TUM. Median follow-up was 142 months (range 15-289). At follow-up spontaneous voiding was seen in 29 patients (69%). Clean intermittent catheterization (CIC) was needed in 14 patients (33%); a urinary diversion was created in 10 patients (24%). In total 32 patients (76%) were dry with no involuntary loss of urine per urethra. Recurrent urinary tract infections were seen in 23 patients (55%). When comparing PSARVUP and TUM groups in our series of patients with short common channels, there were no differences in urological outcome. Normal menstruation was present in 11 of the 20 patients who reached puberty (55%). CONCLUSION: Urogenital functional outcome after reconstructive surgery for cloacal malformations was similar in PSARVUP and TUM groups in patients with short common channels. A thorough urological follow-up is needed to establish the long-term bladder function and urinary incontinence results to prevent long-term risks of recurrent UTI. Albeit without differences between PSARVUP and TUM groups, 45% of the patients present with abnormal or absent menstruations. Gynecological follow-up is mandatory in all patients with cloacal malformations 6 months after the first sign of puberty.
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