[size=20px]Which of the following statements regarding the management and long term outcome of an infant born with cloaca is true?

 

A the incidence of renal insufficiency is less than 15%

 

B the incidence of menstrual obstruction is less than 15%

 

C the incidence of associated gynecological anomalies is less than 15%

 

D vaginoscopy should be performed

 

E decompression of hydrocolpos should be postponed until definitive reconstruction[/size]

(Untitled)

 

D

D

correct

 

One half of patients with cloaca will eventually develop some level of renal failure related both to intrinsic renal disease and chronic obstruction. The risk of subsequent menstrual obstruction in girls with cloaca is 36 to 41%. Some of that risk is due to additional gynecologic abnormalities found in 53 to 67%. Twenty percent of adult patients who underwent cloacal repair as an infant will require additional vaginal reconstruction.

 

Investigation for anomalies such as cloaca and vaginal septae should be performed in all females with anorectal abnormalities. Vaginoscopy performed as part of the initial evaluation or definitive repair can identify these abnormalities and help plan for reconstruction during the optimal exposure afforded during anoplasty. Care of patients with a common channel longer than three centimeters should include surgeons familiar with complex genitourinary reconstruction.

 

Failure to decompress hydrocolpos at presentation can lead to urinary tract obstruction and cervical insufficiency.