title: The surgical outcome of total urogenital mobilization for cloacal repair.
abstract: OBJECTIVE
  Total urogenital mobilization is deemed to preserve the urogenital sinus blood supply and avoid ischemic complications. We report our experience with this technique for cloacal repair.
  
  
  METHODS
  We retrospectively reviewed all consecutive cases of persistent cloaca managed by total urogenital mobilization via a posterior sagittal approach by a single pediatric urologist between 1998 and 2003. During this period 22 girls (12 with a common channel longer than 3 cm) underwent total urogenital mobilization for cloaca repair (1 redo) at a median age of 10 months (range 2 to 102). A total of 15 procedures (68%) could be completed by a perineal approach only. Four patients with a long common channel required additional maneuvers after mobilization to complete the reconstruction.
  
  
  RESULTS
  Urethral stenosis was observed in 2 patients after urethral separation from the vagina (1) and common channel retubularization (1). One child with a perineal hemangioma required a redo posterior sagittal anorectoplasty for complete vaginal and anal closure. In addition, 1 case of urethrovaginal fistula was diagnosed on cystovaginoscopy but was asymptomatic, and 1 child with a minor residual common channel underwent urethral revision to allow easier intermittent catheterization. With a median followup of 48 months (range 11 to 162) the latest examination involving endoscopy with anesthesia showed a good result in 17 patients, a tight introitus that might require further surgery in 3 and a minimal residual common channel of 0.5 cm in 2.
  
  
  CONCLUSIONS
  Total urogenital mobilization is an effective technique for repairing short and long common channels, and a low surgical complication rate can be anticipated.
authors: Pediatric Urology and Pediatric Surgery Departments, Great Ormond Street Hospital for Children, London, United Kingdom. marcdavid.leclair@chu-nantes.fr
authors: Marc-David
authors: MD
authors: Leclair
authors: Mohan
authors: M
authors: Gundetti
authors: Edward M
authors: EM
authors: Kiely
authors: Duncan T
authors: DT
authors: Wilcox
mesh_terms: D002675:Child, Preschool; D002988:Cloaca / Q000002:abnormalities* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000379:methods