Long-term urological outcome of cloaca patients with multidisciplinary management

C Pellegrino; M Agamennone; B D Iacobelli; B Turchi; M L Capitanucci; F Beati; V Forlini; M L Sollini; C E Marras; G Esposito; P Palma; G Della Bella; R D'Urzo; T Caldaro; E Castelli; A Conforti; P Bagolan; G Mosiello

doi:10.1007/s00383-023-05539-2

Long-term urological outcome of cloaca patients with multidisciplinary management

Pediatr Surg Int. 2023 Aug 16;39(1):247. doi: 10.1007/s00383-023-05539-2.

Authors

C Pellegrino¹, M Agamennone^{1

2}, B D Iacobelli³, B Turchi^{1

4}, M L Capitanucci¹, F Beati⁵, V Forlini^{1

2}, M L Sollini^{1

6}, C E Marras⁷, G Esposito⁷, P Palma⁷, G Della Bella⁸, R D'Urzo⁸, T Caldaro⁹, E Castelli¹⁰, A Conforti⁵, P Bagolan¹¹, G Mosiello¹

Affiliations

¹ Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy.
² Pediatric Surgery, University of Genoa, DINOGMI, Largo Paolo Daneo 3, 16132, Genoa, GE, Italy.
³ Neonatal Surgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy. bdaniela.iacobelli@opbg.net.
⁴ Urology Unit, Azienda Ospedaliera Sant'Andrea, 'Sapienza' University of Rome, Via di Grottarossa, 1035/1039, 00189, Rome, RM, Italy.
⁵ Neonatal Surgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy.
⁶ Division of Physical Rehabilitation, University of Tor Vergata, Via Cracovia 50, 00133, Rome, RM, Italy.
⁷ Neurosurgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy.
⁸ Neurorehabilitation and Adapted Physical Activity Day Hospital, Bambino Gesù Children's Hospital IRCCS, 00165, Rome, Italy.
⁹ Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, RM, Italy.
¹⁰ Neurorehabilitation Unit, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy.
¹¹ Neonatal Surgery Unit, Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

PMID: 37584865
DOI: 10.1007/s00383-023-05539-2

Abstract

Purpose: Urological management of Cloacal Malformation (CM) focuses on preserving renal function and continence. Study aim was to analyze urinary and intestinal outcomes in CM patients, considering the length of common channel (CC) and presence of occult spinal dysraphism (OSD).

Methods: Retrospective review of CM treated at our institution by a multidisciplinary team from 1999 to 2020. Patients with follow-up < 2.5 years were excluded. Length of CC, renal function, urinary and bowel outcomes, presence of associated anomalies (especially OSD) were evaluated.

Results: Twenty patients were included, median age at follow-up: 8 years (4-15). A long CC > 3 cm was described in 11 (55%). Chronic kidney disease was found in 3 patients. Urinary continence was achieved in 8/20 patients, dryness (with intermittent catheterization) in 9/20. Fecal continence was obtained in 3/20, cleanliness in 14 (under bowel regimen). OSD was present in 10 patients (higher prevalence in long-CC, 73%). Among OSD, 1 patient reached fecal continence, 7 were clean; 2 achieved urinary continence, while 6 were dry.

Conclusions: Length of CC and OSD may affect urinary and fecal continence. An early counseling can improve outcome at long-term follow-up. Multidisciplinary management with patient centralization in high grade institutions is recommended to achieve better results.

Keywords: Anorectal malformation; Bowel continence; Cloaca; Neurogenic bladder; Occult spinal dysrafism; Urinary continence.

MeSH terms

Adolescent
Animals
Child
Child, Preschool
Cloaca / abnormalities
Humans
Intestine, Large
Neural Tube Defects*
Retrospective Studies
Urinary Incontinence*
Urodynamics