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Paediatric Surgery
Cloaca and Urogenital Sinus with Normal Rectum
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
11 sections · 83 slides
Overview
- What you will learn
What a cloaca is
First principles: one channel where there should be three
- What is a cloaca?
- Sagittal anatomy of a cloaca
- A normal embryo passes through a cloacal stage
- How common is it?
- The three questions that define prognosis
- Two things to rule out before the operating room
- A cloaca with hydrocolpos
Diagnosis and neonatal management
Making the diagnosis at the cot-side and stabilising the baby
- The diagnosis is made by looking, not by scanning
- Single perineal orifice of a cloaca
- The first 24-48 hours: the newborn work-up
- Cystoscopy measures the common channel
- Managing hydrocolpos: drain it permanently
- Colostomy and hydrocolpos drainage in a newborn
- Draining a large or double hydrocolpos
- Choosing where to place the colostomy
- Abdominal film of a cloaca with hydrocolpos
- Re-check, then let the baby grow
Deciding the repair
Timing, and the single measurement that governs everything
- When to do the definitive repair
- Common-channel length: the master variable
- Why the 3 cm line matters
- Long channels carry a harder outlook
Repair of a short channel (<3 cm)
The posterior sagittal approach and total urogenital mobilization
- The plan for a channel shorter than 3 cm
- Positioning and the incision
- Reading the perineum: a prognosis clue
- A good-prognosis perineum
- A poor-prognosis flat perineum
- Down to the white fascia
- The white fascia over rectum and urogenital sinus
- Opening the channel to map the anatomy
- Intrinsic anatomy of a cloaca
- Separating the rectum from the vagina
- The rectum fully separated
- Total urogenital mobilization (TUM)
- Total urogenital mobilization in progress
- Dividing the suspensory ligaments
- Suspensory ligaments of urethra and vagina
- Fully mobilized urethra and vagina
- Rebuilding the female genitalia
- Creating two flaps from the old common channel
- Reconstructed introitus
- Rebuilding the sphincter and finishing
- Completed cloaca reconstruction
Repair of a long channel (>3 cm)
Adding the abdomen: the technically demanding operation
- A different scale of operation
- Turning to the abdomen
- Gaining length on a very high rectum
- Separating vagina from urinary tract: the hard part
- The vaginal switch
- Vaginal switch for widely separated hemi-vaginas
- Replacing the vagina when it is too short
- Two ways to replace the vagina with rectum
- Partial vaginal replacement with colon
- Rectum, small bowel, and checking the uterus
The 1 cm common channel
A short channel treated by introitoplasty
- The very short channel
- A 1 cm common channel exposed
- Introitoplasty
- Introitoplasty completed
The extremely long channel
When higher is paradoxically easier
- Channels of 5-10 cm connecting to the bladder neck
Posterior cloaca
A variant with a normal anus
- What makes a posterior cloaca different
- Posterior cloaca: external appearance and diagram
- Repairing a posterior cloaca
- Trans-anorectal repair of a posterior cloaca
Urogenital sinus with normal rectum
The related defect where the rectum is spared
- What a urogenital sinus is
- Urogenital sinus with a normal anus
- Repairing the urogenital sinus
- Trans-anorectal approach for a long-channel sinus
Newer approaches and key messages
Laparoscopy and the take-home points
- The laparoscopic approach
- Take-home messages
- Viva: Why does common-channel length matter so much in cloaca?
- References (1/2)
- References (2/2)
- Pediatric Surgery and Pediatric Urology