title: Adolescent and adult outcomes in women following childhood vaginal reconstruction for cloacal anomaly.
abstract: OBJECTIVE
  We examined outcomes in female adolescents and women who underwent vaginoplasty in childhood during genitourinary reconstruction for cloacal anomalies.
  
  
  METHODS
  We retrospectively reviewed the medical notes on girls and women attending an adult specialist center for genitourinary anomalies. Data were collected on vaginal reconstruction, menstruation, sexual and reproductive function, and urological and gastroenterological outcomes.
  
  
  RESULTS
  We identified 19 patients with a mean age of 22 years (range 13 to 35), of whom 16 (84%) underwent vaginoplasty in the first year of life. Nine of these 16 patients (56%) had required 1 (7) or 2 (2) further vaginal reconstructions to facilitate menstruation or sexual activity. The remaining 7 patients (44%) required no further vaginal reconstruction. Nine of the 19 patients (47%) had associated müllerian anomalies, obstructed menstruation developed in 5 (26%) and 1 required hemihysterectomy. Eight patients were sexually active, of whom 1 experienced difficult penetration. Three patients attempted to conceive, including 1 with a complex preterm delivery and 2 undergoing fertility treatment. Of the patients 74% underwent further reconstruction of the renal tract and 36% had an enteric stoma.
  
  
  CONCLUSIONS
  This study confirms the complexity of vaginal reconstruction in this group with a notable vaginoplasty revision rate. Müllerian anomalies were identified in almost half of the patients, a higher incidence than previously reported, and in a quarter obstructed menstruation developed in puberty. A specialist team with gynecologic input should treat patients with cloacal anomalies. Outcome data are sparse. There remains a need for well planned, prospective cohort studies that include assessments of psychological, sexual and reproductive outcomes.
authors: National Hospital for Neurology and Neurosurgery, London, United Kingdom.
authors: Ashani
authors: A
authors: Couchman
authors: University College London Institute of Women's Health, London, United Kingdom.
authors: Sarah M
authors: SM
authors: Creighton
authors: University College London Hospitals, London, United Kingdom.
authors: Dan
authors: D
authors: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D002988:Cloaca / Q000002:abnormalities*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007668:Kidney / Q000002:abnormalities; D008599:Menstruation Disturbances / Q000209:etiology; D009095:Mullerian Ducts / Q000002:abnormalities; D019651:Plastic Surgery Procedures; D012086:Reoperation; D014564:Urogenital Abnormalities / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D014621:Vagina / Q000601:surgery*; D055815:Young Adult
keywords: cloaca; reconstructive surgical procedures; treatment outcome; urogenital abnormalities; vagina