Surgical management and early outcomes of cloacal exstrophy: a single-center experience

Cloacal exstrophy is the most severe form of the bladder exstrophy–epispadias complex and remains one of the rarest congenital anomalies encountered in pediatric surgery. Owing to its complex anatomy and associated multisystem abnormalities, optimal surgical timing and long-term management strategies continue to be debated. To describe the clinical characteristics, surgical management, and early- to mid-term outcomes of neonates with cloacal exstrophy treated at a tertiary referral center. A retrospective review was performed using a prospectively maintained bladder exstrophy–epispadias complex database. Four consecutive neonates with cloacal exstrophy treated between 2013 and 2024 were included. Clinical management consisted of early neonatal stabilization followed by staged abdominal reconstruction and either simultaneous or delayed pelvic osteotomy according to individual anatomical and clinical characteristics. Renal function, vesicoureteral reflux (VUR), early continence-related indicators, orthopedic outcomes, growth parameters, postoperative complications, and quality-of-life measures were evaluated after a minimum follow-up of 24 months. Two patients underwent primary bladder closure with simultaneous pelvic osteotomy during the first week of life, whereas two underwent delayed staged reconstruction. Patients managed with early pelvic osteotomy demonstrated a trend toward better preservation of renal function, earlier VUR regression, and more favorable orthopedic findings. One patient developed short bowel syndrome requiring prolonged parenteral nutrition and experienced recurrent catheter-related sepsis and growth impairment. Daytime dry intervals were achieved in three patients, while limited nighttime dryness was observed in one patient. Patients with a more stable clinical course also demonstrated higher quality-of-life scores during follow-up. Cloacal exstrophy requires coordinated multidisciplinary management extending beyond anatomical reconstruction alone. In this small case series, early pelvic osteotomy was associated with favorable trends in renal and orthopedic outcomes; however, these observations should be interpreted cautiously because of the limited sample size. Larger multicenter studies with standardized long-term follow-up are needed to validate these findings.