Bladder function after total urogenital mobilization for persistent cloaca.
OBJECTIVE
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.


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.
Matsui
Futoshi
F
Department of Urology and Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. f.matsui@mch.pref.osaka.jp
Shimada
Kenji
K
Matsumoto
Fumi
F
Obara
Takashi
T
Kubota
Akio
A
D002988:Cloaca / Q000002:abnormalities* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000502:physiology*; D014549:Urinary Incontinence / Q000517:prevention & control; D014563:Urodynamics; D014566:Urogenital System; D013520:Urologic Surgical Procedures / Q000379:methods