Diagnosis and surgical management of persistent cloaca in girls

OBJECTIVE: To improve diagnostic accuracy and postoperative outcomes in patients with persistent cloaca. MATERIAL AND METHODS: The study enrolled 33 female patients with persistent cloaca between 2021 and 2025. All patients underwent ultrasound, MRI, contrast cloacoscopy, and distal colostography. Diagnostic laparoscopy was performed when necessary. Anatomical variations, concomitant malformations, surgical techniques, and postoperative complications were analyzed. RESULT: Total length of common channel was up to 2.0 cm in 43.3% of patients, 2.1-3.5 cm - in 50.0%, >4.0 cm - in 6.7%. Posterior sagittal anorecto-urethro-vaginoplasty was performed in 83.3% of cases. Two patients with long and narrow channels underwent laparoscopic or open abdominal-perineal approaches. Colostomy-related complications occurred in 7 patients (evagination), wound dehiscence - 2, isolated fecal incontinence - 1, combined urinary and fecal incontinence - 1. The last one was managed using a bowel management program (laxatives, enemas, dietary modifications) and secondary colostomy. Other patients experienced no complications. The maximum follow-up period exceeds 5 years. CONCLUSION: Length of common channel and anatomical configuration of cloacal malformations are essential for surgical planning and functional prognosis. Successful treatment depends on comprehensive diagnosis, timely colostomy and staged reconstruction in a specialized hospital.