Repair of “bladder neck” cloaca using a trans-vesicle approach: A case report

Introduction Cloaca with a common channel greater than 3 cm typically requires urogenital separation rather than total urogenital mobilization. The purpose of this report was to describe our experience managing a female infant with an usual form of cloaca where all structures inserted onto the bladder neck. Case presentation A female infant with a single perineal opening underwent loop sigmoid colostomy shortly after birth. She voided spontaneously and had no hydrocolpos. She underwent exam under anesthesia, cystoscopy, and cloacogram under a single anesthetic at 5 months of age. This revealed five structures that inserted directly into the bladder: a central rectal fistula, two hemivaginas and hemiuteri bilaterally, and two ureters without hydronephrosis. The outflow tract was a long common channel measuring 5.2 cm. This patient was reviewed in a multidisciplinary setting and underwent repair at 10 months of age. We performed a midline laparotomy and opened the anterior wall of the bladder to visualize the structures that inserted posteriorly. Foley catheter and ureteric stents were placed. The rectal fistula and hemivaginas were mobilized off the bladder internally. Vaginal replacement was performed using a transverse portion of rectum. Additional colonic length was achieved by converting the loop colostomy to an end-loop. The abdomen was closed and posterior sagittal anorectoplasty was performed in a prone position. Conclusion This infant underwent repair of a “bladder neck” cloaca using a transvesicular approach. She is now 35 months of age and thriving. She developed neurogenic bladder requiring clean intermittent catheterization and is working on fecal continence.