Therapeutic strategy for persistent cloaca: the efficacy of antegrade continent enema as a salvage surgery.
OBJECTIVE
The aim of this study is to evaluate our therapeutic strategy for persistent cloaca from the viewpoint of long-term functional outcome.


METHODS
This study covers 17 cases of persistent cloaca treated at our institution and followed for more than 3 years. As a definitive repair for anorectal and urogenital systems, simultaneous surgery with posterior sagittal approach or anorecto-urethrovagino-plasty (PSARUVP) was performed. The length of the common channel and the shape of the vagina determined the vaginoplasty methods. Fecal function was assessed with the scoring system of the Japan Study Group of Anorectal Anomalies.


RESULTS
Anorectoplasty was performed with the posterior sagittal approach in 15 cases and with the perineal approach in two. Vaginoplasty was performed with total urogenital mobilization in nine cases, rectal interposition in four, vaginal flap in two and with other methods. Fecal function was classified as good in three cases, moderate in ten, and poor in four. In the poor cases, Malone's antegrade continence enema (MACE) was performed, which improved fecal function significantly.


CONCLUSIONS
PSARUVP might be the optimal surgery for persistent cloaca at present; however, satisfactory fecal function could not be achieved in those cases with a longer common channel. MACE effectively compensated for the poor outcome and was especially successful at eliminating incontinence.
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, 594-1101, Japan. kubota@mch.pref.osaka.jp
Akio
A
Kubota
Keigo
K
Nara
Hisayoshi
H
Kawahara
Akihiro
A
Yoneda
Hiroshi
H
Nakai
Taro
T
Goda
Soji
S
Ibuka
Futoshi
F
Matsui
Kenji
K
Shimada
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002988:Cloaca / Q000002:abnormalities* / Q000601:surgery*; D004733:Enema; D005260:Female; D006801:Humans; D012007:Rectum / Q000601:surgery; D014521:Urethra / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods*; D014621:Vagina / Q000601:surgery; D055815:Young Adult
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