Persistent cloaca in the gynecologist's practice (a literature review)


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Introduction. Cloacal abnormalities are rare congenital malformations having the most severe and complex forms of anorectal and urogenital malformations. Patients - always females who are born with the persistent cloaca - at the stage of embryogenesis had a merging of lower urethra, vagina and rectum into a single canal or cavity which is opened posterior to the clitoris. The persistent cloaca remains a challenging reconstructive problem for pediatric gynecologists, urologists and surgeons. Doctors must have skills in surgical urology, proctology and in all types of plastic surgery on the vagina and cervix.

Material and methods. Data searches were conducted in PubMed and Google Scholar. The following keywords were used: “Cloacal abnormalities” and “Persistent cloaca”.

Conclusion. Regardless of a technique, goals for cloaca management remain the same. The primary surgical procedure is aimed to restore normal anatomical positioning of pelvic organs and to form the urethra, vagina and rectum as well as to achieve control over bowel function, urination and reproductive potential of the patient. A surgical correction of persistent cloaca should be performed in specialized medical institutions by specialists having experience in treating children with anorectal anomalies.

About the authors

L. V. Adamyan

A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Author for correspondence.
Email: fake@neicon.ru
ORCID iD: 0000-0002-3253-4512

Moscow, 127473, Russian Federation

Russian Federation

S. M. Sharkov

Sechenov First Moscow State Medical University; Morozovskaya Children’s City Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0002-9563-6815

Moscow, 119048, Russian Federation

Moscow, 119049, Russian Federation

Russian Federation

E. V. Sibirskaya

A.I. Yevdokimov Moscow State University of Medicine and Dentistry; Russian Children’s Clinical Hospital, Pirogov Russian National Research Medical University

Email: elsibirskaya@yandex.ru
ORCID iD: 0000-0002-4540-6341

Elena V. Sibirskaya – MD, Dr. Sc.(med), professor at the chair of reproductive medicine and surgery

Moscow, 127473, Russian Federation

Moscow, 119571, Russian Federation

Russian Federation

L. G. Pivazyan

Sechenov First Moscow State Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0002-6844-3321

Moscow, 119048, Russian Federation

eLibrary SPIN: 3949-2120

Russian Federation

D. S. Avetisyan

Sechenov First Moscow State Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0002-3750-7054

Moscow, 119048, Russian Federation

Russian Federation

References

  1. Raffensperger J, Ramenofsky M. The management of a cloaca. J Pediatr Surg. 1973; 8(5): 647–57. https://doi.org/10.1016/0022-3468(73)90403-x
  2. Warne S., Wilcox D., Creighton S., Ransley P. Long-Term Gynecological Outcome of Patients with Persistent Cloaca. Journal of Urology. 2003; 170 (4 Part 2): 1493–6. https://doi.org/10.1097/01.ju.0000086702.87930.c2
  3. Matsui F., Shimada K., Matsumoto F., Obara T., Kubota A. J. Urol. 2009; 182: 2455–9.
  4. Peña A, Levitt M. Anorectal Malformations. Pediatric Surgery. 2006: 1566–89. https://doi.org/10.1016/b978-0-323-02842-4.50104-2
  5. Peña A. Total urogenital mobilization – An easier way to repair cloacas. Journal Of Pediatric Surgery. 1997; 32(2): 263–8. https://doi.org/10.1016/s0022-3468(97)90191-3
  6. Caldwell B., Wilcox D. Long-term urological outcomes in cloacal anomalies. Seminars In Pediatric Surgery. 2016; 25(2): 108–11. https://doi.org/10.1053/j.sempedsurg.2015.11.010
  7. Лѐнюшкин А.И., Комиссаров И.А. Педиатрическая колопроктология. М.: 2009; 398.
  8. Осипкин В.Г., Балаганский Д.А. Хирургическая тактика при аноректальных пороках развития. Настоящее и будущее детской хирургии: Материалы конференции. М.: 2001; 193.
  9. Q i B Q., Williams A., Beasley S., et al. C larifi cation of the process of separation of the cloaca into rectum and urogenital sinus in the rat embryo. J Pediatr Surg. 2000; 35: 1810–16.
  10. Recklinghausen V. Untersuchungen uber die Spina bifi da. Virchows Arch Pathol Anat. 1886; 105: 373–455 .
  11. Hendren W.H. Cloaca, the most severe degree of imperforate anus: experience with 195 cases. Ann Surg. 1998; 228: 331–46.
  12. Cilento B.G., Jr, Benacerraf B.R., Mandell J. Prenatal diagnosis of cloacal malformation. Urology. 1994; 43: 386–8 .
  13. Kubota M., Osuga Y., Kato K., Ishikura K., Kaneko K., Akazawa K. et al. Treatment guidelines for persistent cloaca, cloacal exstrophy, and Mayer–Rokitansky–Küster–Häuser syndrome for the appropriate transitional care of patients. Surgery Today. 2019; 49(12): 985-1002. https://doi.org/10.1007/s00595-019-01810-z
  14. Novozilov V., Stepanova N., Kozlov Y., Rasputin A., Milyukova L., Petrov E., Petrov Y. Correction of persistent cloaca in children: experience and analysis of treatment results. Medical Almanac. 2019; (5–6): 50–3. https://doi.org/10.21145/2499-9954-2019-5-50-53
  15. Морозов Д.А., Окулов Е.А., Пименова Е.С. Российский консенсус по хирургическому лечению детей с аноректальными пороками. Первые шаги. Российский вестник детской хирургии, анестезиологии и реаниматологии. 2013; 4: 8–14.
  16. Holschneider A., Hutson J., Pe a A., Beket E., Chatterjee S., Coran A. et al. Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations. J. Pediatr. Surg. 2005; 40: 1521–6.
  17. Kubota M. The current profile of persistent cloaca and cloacal exstrophy in Japan: the results of a nationwide survey in 2014 and a review of the literature. Pediatr Surg Int. 2017; 33(4): 505–12.
  18. Kay R, Tank ES. Principles of management of persistent cloaca in the female newborn. J Urol. 1977; 117: 102–4.
  19. Отамурадов Ф.А., Эргашев Н.Ш. Персистирующая клоака у девочек. Проблемы диагностики и хирургической коррекции. Российский вестник детской хирургии, анестезиологии и реаниматологии. 2016; 4(4): 37–42.
  20. Сибирская Е.В., Адамян Л.В., Яцык С.П., Гераськина С.Г. Боли в животе у девочек, связанные с гинекологической патологией: ошибки диагностики и лечения. Педиатрическая фармакология. 2014; 11(4): 23–8.
  21. Kirgizov I., Minaev S., Gladkij A., Shishkin I., Shakhtarin A., Aprosimov M. et al. Multicenter research of persistent cloacal malformation surgery in children. Medical News Of The North Caucasus. 2014; 9(4): https://doi.org/10.14300/mnnc.2014.09083
  22. Begum A, Sheikh A, Mirza B. Reconstructive surgery in a patient with persistent cloaca. APSP J Case Rep. 2011; 2: 23.
  23. Caldwell B., Wilcox D. Long-term urological outcomes in cloacal anomalies. Seminars In Pediatric Surgery. 2016; 25(2): 108–11. https://doi.org/10.1053/j.sempedsurg.2015.11.010
  24. Warne S., Hiorns M., Curry J., Mushtaq I. Understanding cloacal anomalies. Archives Of Disease In Childhood. 2011; 96(11): 1072–6. https://doi.org/10.1136/adc.2009.175034
  25. AbouZeid A., Radwan A., Eldebeiky M., Hay S. Persistent cloaca: persistence of the challenge. Annals Of Pediatric Surgery. 2020; 16(1). https://doi.org/10.1186/s43159-019-0010-z
  26. НиколаевВ.В.. Персистирующая клоака: современный подход в решении проблемы. Репродуктивное здоровье детей и подростков. 2016; 3. 45–6.
  27. Pen˜ a A. Anorectal malformations. Semin Pediatr Surg. 1995; 4: 35.
  28. Levitt M.A. Stein D.M. Pena A. Gynecologic concerns in the treatment of teenagers with cloaca. J Pediatr Surg. 1998; 33: 188.
  29. Pen˜ a A. Anorectal malformations. Semin Pediatr Surg. 1995; 4: 35.
  30. Levitt M.A. Stein D.M. Pena A. Gynecologic concerns in the treatment of teenagers with cloaca. J Pediatr Surg. 1998; 33: 188.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c)

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies