Korean J Urol.  2008 Jan;49(1):77-81.

Clinical Characteristics of Children with Persistent Cloaca: A Urological Perspective

• Bang WJ
• Lee HY
• Han SW

Abstract

PURPOSE: Persistent cloaca is a rare multiple anomalous condition which involves the gastrointestinal, neurological and urogenital systems. We evaluated the clinical characteristics and urogenital anomalies of patients with persistent cloaca, and we investigated the factors that must be considered from a urological perspective.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 11 patients who were diagnosed with persistent cloaca at our institution during the last 7 years.
RESULTS
Nine of the 11 patients who were followed up at the urology clinic were subjected to this study. Nonspecific abnormalities, such as antenatal hydronephrosis, were noted in 5 of 9 patients. The chief complaints upon visits to the urologic clinic were recurrent urinary tract infections in 3, preoperative evaluation before neurosurgery in 3, urinary incontinence in 1, urinary retention in 1 and an elevated creatinine level in 1. The urological anomalies included 2 cases of renal agenesis and 1 horseshoe kidney. Vesicoureteral reflux was noted in 6 patients, and 4 of these patients underwent antireflux surgery. Videourodynamic study was performed in 8 patients and all of them were diagnosed with neurogenic bladder. Currently, 5 children are on intermittent catheterization, 2 have undergone vesicostomy and 2 void spontaneously.
CONCLUSIONS
Most patients with persistent cloaca had urological anomalies of the upper urinary tract and neurogenic bladder. Therefore, a multidisciplinary approach for diagnosis and treatment from various departments, including the urology, pediatric surgery, neurosurgery departments is mandatory.

Keyword

Cloaca; Urogenital abnormalities

MeSH Terms

Catheterization
Catheters
Child
Cloaca
Congenital Abnormalities
Creatinine
Cystostomy
Humans
Hydronephrosis
Kidney
Kidney Diseases
Medical Records
Neurosurgery
Retrospective Studies
Urinary Bladder, Neurogenic
Urinary Incontinence
Urinary Retention
Urinary Tract
Urinary Tract Infections
Urogenital Abnormalities
Urogenital System
Urology
Vesico-Ureteral Reflux
Congenital Abnormalities
Creatinine
Kidney
Kidney Diseases

Reference

1. Moore K, Persaud T. The developing human: clinically oriented embryolory. 2003. 7th ed. Philadelphia: WB Saunders;256–328.

2. Cilento BG Jr, Benacerraf BR, Mandell J. Prenatal diagnosis of cloacal malformation. Urology. 1994. 43:386–388.

3. Zderic SA, Canning DA, Carr MC, Kodman-Jones C, Synder HM. The CHOP experience with cloacal exstrophy and gender reassignment. Adv Exp Med Biol. 2002. 511:135–147.

4. Bianchi DW, Crombleholme TM, D'Alton ME. Fetology. 2000. 1st ed. New York: McGraw-Hill;460–466.

5. Kim DY, Kim KS, Park WH, Choi SO. Urologic anomalies associated with imperforated anus. Korean J Urol. 1995. 36:65–69.

6. Mildenberger H, Kluth D, Dziuba M. Embryology of bladder exstrophy. J Pediatr Surg. 1988. 23:166–170.

7. Vermeij-Keers C, Hartwig NG, Van der Werff JF. Embryonic development of the ventral body wall and its congenital malformations. Semin Pediatr Surg. 1996. 5:82–89.

8. Zaccara A, Gatti C, Silveri M, Rivosecchi M, Bilancioni E, Spina V, et al. Persistent cloaca: Are we ready for a correct prenatal diagnosis? Urology. 1999. 54:367.

9. Ohno Y, Koyana N, Tsuda M, Arii Y. Antenatal ultrasonographic appearance of a cloacal anomaly. Obstet Gynecol. 2000. 95:1013–1015.

10. Lande IM, Hamilton EF. The antenatal sonographic visualization of cloacal dysgenesis. J Ultrasound Med. 1986. 5:275–278.

11. Mandell J, Lillehei CW, Greene M, Benacerraf BR. The prenatal diagnosis of imperforate anus with rectourinary fistula: dialted fetal colon with endolithiasis. J Pediatr Surg. 1992. 27:82–84.

12. Hendren WH. Urological aspects of cloacal malformations. J Urol. 1988. 140:1207–1213.

13. O'Flynn KJ, Gough DC, Gupta S, Lewis MA, Postlethwaite RJ. Prediction of recovery in antenatally diagnosed hydronephrosis. Br J Urol. 1993. 71:478–480.

14. Brock WA, Pena A. Kelais PP, King LR, Belman AB, editors. Cloacal abnormalities and imperforate anus. Clinical pediatric urology. 1992. 3rd ed. Philadelphia: WB Saunders;920–942.