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Cloaca
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Low surgical volume is one reason for poor outcomes and the need for reoperations in anorectal malformation surgery, supporting the case for regional centers of expertise — Marc Levitt, Is Multi-disciplinary care the future of medicine? · 24:50
Fetal Genitourinary Diseases and Bladder Outlet Obstruction: Fetal...
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Dr. Todd Ponsky andDr. Polzin, introduce the event and the panel faculty. Dr. Polzinbegins the event with a discussion on fetal genitourinary disease and fetal bladder outlet obstruction.
video3:45 · Jan 2019
Is Multi-disciplinary care the future of medicine?
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Children's National Medical Center, Anesthesiology Grand Rounds Part 1 - August 31, 2023
Marc Levitt, MD
video24:50 · Oct 2023
The recommended neonatal management for cloaca is to drain hydrocolpos, open a colostomy, and re-evaluate from the urologic point of view 48 hours later before making further decisions. — Alberto Peña, Cloaca - Workup & Evaluation · 19:14
Cloaca - Prental Imaging & Diagnosis - Counseling
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Dr. Todd Ponsky introduces the event. Dr. Belinda Hsi Dickie, surgical director of hemangioma and vascular malformations center at Cincinnati Children's Hospital, introduces the panel guests andbegins the event with a discussion on cloaca a
video36:15 · Nov 2018
Cloaca - Workup & Evaluation
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Dr. Manish N Patel,pediatric interventional radiologist and an associate professor of radiology, presents on complex cloacal malformations anduses of rotational Fluoroscopy and 3-D reconstruction. Dr. Patel covers topics on 3D rotational fl
video20:22 · Nov 2018
Prenatal Imaging and Counseling: Cloaca and Complex ARMs 2015
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Dr. Belinda Hsi Dickie, surgical director of hemangioma and vascular malformations center at Cincinnati Children's Hospital, introduces the panel guests and begins the event with a discussion on cloaca and other complex malformations. Topic
video31:23 · Jan 2019
3D Reconstruction: Cloaca and Complex ARMs 2015
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Dr. Manish N Patel, Pediatric Interventional Radiologist and an Associate Professor of Radiology at Cincinnati Children's Hospital, presents on complex cloacal malformations and the use of rotational fluoroscopy and 3D reconstruction. Dr. P
video20:20 · Jan 2019
Anorectal Malformation Radiology: Pediatric Colorectal Controversies 2014
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Drs Marc Levitt, Rama Jayanthi, Carlo Di Lorenzo, and Karen Diefenbach host a half day symposiumhighlighting new concepts and controversies in pediatric colorectal anomalies, primarily focusing on anorectal malformations.Discussion is based
video1:01:48 · Jan 2019
Assessment of reproductive structures should begin 6 to 9 months after the onset of puberty to evaluate estrogen effects on the Müllerian system. Gynecologic Concerns: Cloaca and Complex ARMs · 4:00
Gynecologic Concerns: Cloaca and Complex ARMs
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Dr. Lesley Breech, Division of Pediatric and Adolescent Gynecology, gives a presentation on gynecologic concerns of cloacal anomaly. She discusses surgical management and long-term risks of the operation.
video34:57 · Jan 2019
Enhancing Urethral Meatus Creation in Cloacal Malformations: A New Technique
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Pediatric Colorectal & Pelvic Reconstruction | Children's National Hospital (childrensnational.org)
video4:41 · Aug 2025
Enhancing Urethral Meatus Creation in Cloacal Malformations: A New Technique
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Colorectal
video4:41 · Aug 2025
Annual surveillance for cloaca patients should include renal ultrasound and history up until toilet training age. Cloaca - Urologic Concerns · 0:00
Cloaca - Urologic Concerns
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Dr. Brian A. VanderBrink,Urologist and an Assistant Professor atUC Department of Pediatrics,presents on Urology risk Stratification. Dr. VanderBrink'sdiscussion includes topics onrisk factors for Urologic dysfunction such as UTI risk as wel
video25:29 · Nov 2018
Complications and Long-Term Outcomes of Patients With Cloacal Malformation After Bowel Neovagina...
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Dr. Megan Reed Ivaturi from Nationwide Children's Hospital discusses a recent study published in the Journal of Pediatric Surgery on the long-term outcomes of bowel neovagina creation for patients with cloacal malformations. The study evalu
video1:05 · Jun 2026
Common channel length alone is inadequate for guiding prognosis in cloacal malformations. — Kat Ford, Dr. Kat Ford - Best of the Best in Pediatric Surgery 2025 · 6:00
Dr. Kat Ford - Best of the Best in Pediatric Surgery 2025
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Watch BAPS' Dr. Kat Ford’s presentation on “Evaluating prognosis in cloaca: an analysis of common channel length and bowel function outcome” at the 2025 Best of the Best in Pediatric Surgery event!
Moderators: Drs. Todd Ponsky, Dan von A
video10:08 · Mar 2025
Post-discharge follow-up focuses on ensuring kidneys are well decompressed, patient is growing well, following kidney function tests, and ensuring parents manage stoma effectively. — Richard Wood, Colorectal Quiz Episode 17: Cloaca Part 1 · 24:36
Cloaca - Case Presentations
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Dr.Belinda His Dickie, surgical director of the Hemangioma and Vascular Malformations Center, presents cloaca cases fordiscussion. Case 1 describes a newborn 34 week old female with a diagnosis of pelvic collection and hydropnephrosis by ul
video45:15 · Nov 2018
Cloaca - Long Common Channel
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Dr. Belinda Hsi Dickie presents a case regarding a 12 month old female with a history of cloaca and approaches to management of a long common channel. Approaches to this case werediscussed amongst the panel members. A second case was presen
video14:55 · Nov 2018
Collaborative work: Complex Pediatric Anorectal Malformations 2017
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During this session, Drs Michael Helmrath, Jason Frischer, andTodd Ponsky discuss the importance of collaborative work in complex pediatric anorectal malformation.
video23:45 · Jan 2019
Case Presentations Part II: Cloaca and Complex ARMs 2015
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Dr. Belinda Hsi Dickie, surgical director of the Hemangioma and Vascular Malformations Center, presents additional cloaca cases for discussion.
video14:22 · Jan 2019
Case Presentations Part I: Cloaca and Complex ARMs 2015
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Dr. Belinda Hsi Dickie, surgical director of the Hemangioma and Vascular Malformations Center, and Dr. Lesley Breech, Division Director of Pediatric and Adolescent Gynecology, present cloaca cases for discussion.
video45:15 · Jan 2019
Colorectal Quiz Episode 17: Cloaca Part 1
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The treatment for cloacal malformations are a great example of collaboration between pediatric colorectal surgery, gynecology, and urology. In today's episode, Dr. Marc Levitt and Dr. Jason Frischer talk to Dr. Richard Wood about the initia
podcast27:29 · Jul 2021
Colorectal Quiz Episode 18: Cloaca Part 2
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The treatment for cloacal malformations are a great example of collaboration between pediatric colorectal surgery, gynecology, and urology. In today's episode, Dr. Marc Levitt and Dr. Jason Frischer talk to Dr. Richard Wood about the operat
podcast23:10 · Jul 2021
Colorectal Quiz Episode 24: Cloaca Part 3
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The treatment for cloacal malformations are a great example of collaboration between pediatric colorectal surgery, gynecology, and urology. In today's episode, Dr. Marc Levitt and Dr. Jason Frischer talk to Dr. Richard Wood about the operat
podcast45:10 · Feb 2022
Colorectal Quiz: Episode 47
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In this episode of the Colorectal Quiz, Drs. Marc Levitt, Jason Frischer, and special guests Dr. Chris Gayer and Dr. Sarah Ulrich tackle the complexities of man
podcast22:19 · Jul 2026
Colorectal Quiz: Episode 40
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In this insightful podcast, Drs. Marc Levitt, Jason Frischer, and Chris Westgarth-Taylor discuss the challenging anatomy and surgical strategies for complex fem
podcast18:43 · Jul 2026
Colorectal Quiz Episode 18: Cloaca Part 2
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The treatment for cloacal malformations are a great example of collaboration between pediatric colorectal surgery, gynecology, and urology. In today
podcast23:10 · Jul 2026
Colorectal Quiz Episode 17: Cloaca Part 1
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The treatment for cloacal malformations are a great example of collaboration between pediatric colorectal surgery, gynecology, and urology. In today
podcast27:32 · Jul 2026
The vagina must be drained immediately in hydrocolpos, first attempting catheter placement confirmed by ultrasound, or creating a vaginostomy if catheterization fails or is inadequate. Fetal and Newborn Management of Cloacal Malformations · 7:50
Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison
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Marc Levitt, MD discusses Cloaca with Todd Ponsky, MD and Aaron Garrison, MDEdited by Ian C Glenn, MD and Sophia Abdulhai, MDDr. Levitt is surgical director of the Center for Colorectal and Pelvic Reconstruction as well as program director
podcast43:47 · Jan 2019
Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison
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Marc Levitt, MD discusses Cloaca with Todd Ponsky, MD and Aaron Garrison, MDEdited by Ian C Glenn, MD and Sophia Abdulhai, MDDr. Levitt is surgical director of the Center for Colorectal and Pelvic Reconstruction as well as program director
podcast43:47 · Dec 2020
ERN eUROGEN ARM Webinar Series: Management of Cloacal Malformations – what is new in 2021?
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eUROGEN ARM Webinars Series, October 2021
This webinar will be presented by Dr. Marc Levitt from the Children’s National Hospital in Washington D.C.
The management of cloacal malformations, including prenatal diagnosis, newborn trea
video48:03 · Dec 2022
2019 Chandler Lecture: Dr. Marc Levitt
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The Division of Pediatric Surgery hosts an annual lecture in honor of Dean Loren "Yank" Chandler. This year's speaker, Dr. Marc Levitt, chief of the Colorectal and Pelvic Reconstruction Surgery Section at Nationwide Children's Hospital, pre
video41:23 · Jul 2026
Time for some patient driven change | Marc Levitt | TEDxColumbus
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Patient driven care - how a patient made me a better doctor, how a collaborative process improves care, and why this is so rare and hard to achieve in medicine.
Marc Levitt, MD, is the Surgical Director of the Center for Colorectal and Pel
video10:41 · Jul 2026
Fetal and Newborn Management of Cloacal Malformations
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Fetal and Newborn Management of Cloacal MalformationsTune in as we explore the complex world of cloacal malformations, a rare congenital anomaly affecting female newborns. This episode breaks down the critical steps from prenatal diagnosis
podcast13:53 · Sep 2026
Examination should be performed after onset of puberty and menstruation but before sexual debut Cloaca - Gynecologic Concerns · 20:09
Cloaca - Gynecologic Concerns
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Dr. Breech,Division of Pediatric and Adolescent Gynecology,gives a presentation of gynecologic concerns of cloacal anomaly. Here presentation includes topics of menstrual obstruction issues, hydrocolpos, reproductive recommended management,
video35:24 · Nov 2018
Surgical Management and Follow-Up: Cloaca and Complex ARMs 2015
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Dr. Shumyle Alam, specialist in pediatric pelvic and urogenital reconstruction, presents on cloaca surgical management and follow-up. Dr. Alam covers topics on neurogenic bladder and follow-up monitoring of blood pressure and glomerular fil
video25:14 · Jan 2019
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Expert statements from the recordings in this collection.
Fetal and Newborn Management of Cloacal Malformations
Cloacal malformations occur only in females with an incidence of approximately 1 in 50,000 births.
Host summaryThe host summarizing the discussion — not the host's own clinical position0:21 ↗
In cloacal malformations, the GI tract, urinary system, and gynecologic tract all exit through a single opening due to failure of separation during development.
Host summaryThe host summarizing the discussion — not the host's own clinical position0:21 ↗
Abdominal or pelvic cystic masses are found on prenatal ultrasound in 52% of cloacal malformation cases.
epidemiological1:21 ↗
Hydronephrosis is seen on prenatal ultrasound in approximately 49% of cloacal malformation cases.
epidemiological1:32 ↗
Intraluminal calcifications are a specific prenatal ultrasound finding for cloacal malformations, forming when urine mixes with meconium inside the body, indicating communication between bowel and urinary tract.
clinical1:44 ↗
Up to 70% of non-syndromic cloacal malformation patients have VACTERL association.
epidemiological2:25 ↗
VACTERL association is defined as having 3 or more of the following: vertebral defects, anorectal malformations, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb defects.
clinical2:41 ↗
Vaginal delivery is often safe and feasible for cloacal malformations.
clinical4:02 ↗
Delivery must occur at a specialized tertiary care center with a top-level NICU and subspecialists available.
guideline4:07 ↗
Immediate postnatal priorities include stabilizing breathing and circulation, obtaining IV access, starting antibiotics, and ensuring urine and stool can exit the body.
guideline4:27 ↗
Initial NICU stay typically lasts 2 to 3 weeks for stabilization and early procedures.
clinical4:50 ↗
Definitive reconstructive surgery for cloacal malformations is usually performed between 3 and 12 months of age.
guideline4:57 ↗
Passing a nasogastric tube immediately after birth checks for esophageal atresia or tracheoesophageal fistula, which occurs in 7-11% of babies with anorectal malformations.
clinical5:22 ↗
Cardiac defects occur in up to 40% of cloacal malformation cases, requiring early echocardiogram before considering abdominal surgery.
epidemiological5:40 ↗
The proper physical examination technique for cloacal malformations requires gently lifting the labia edges upwards and outwards toward the examiner's shoulders to visualize the single small orifice.
clinical6:07 ↗
The common misdiagnosis error is identifying a cloacal malformation as a rectovaginal fistula; true rectovaginal fistulas are extremely rare.
clinical6:31 ↗
Hydrocolpos is found in up to one-third of cloacal malformation cases and can be lethal if not managed quickly.
clinical7:00 ↗
Hydrocolpos results from massive distention of the shared vaginal structure with trapped fluid (urine and mucus) when the single exit opening is inadequate.
clinical7:05 ↗
The distended vagina in hydrocolpos compresses the bladder, blocking both ureterovesical junctions and causing severe bilateral hydroureteronephrosis.
clinical7:25 ↗
The vagina must be drained immediately in hydrocolpos, first attempting catheter placement confirmed by ultrasound, or creating a vaginostomy if catheterization fails or is inadequate.
guideline7:50 ↗
Vaginal drainage must be performed before considering other urologic surgeries like vesicostomy or nephrostomy tubes, as the hydroureteronephrosis is caused by vaginal compression of the bladder.
guideline8:13 ↗
Over 80% of cloacal malformation patients have associated urinary tract anomalies.
epidemiological8:46 ↗
Vesicoureteral reflux (VUR) is seen in approximately 50% of cloacal malformation patients.
epidemiological8:51 ↗
Hydronephrosis occurs in 30% of cloacal malformation patients.
epidemiological8:57 ↗
Between 50% and 75% of cloacal malformation patients will develop chronic kidney disease over their lifetime.
epidemiological8:57 ↗
Approximately 17% of cloacal malformation patients eventually progress to end-stage renal disease requiring dialysis or transplant.
epidemiological9:06 ↗
Colostomy creation is typically performed within 24 to 48 hours after birth as the second major surgical priority.
guideline9:22 ↗
The ideal colostomy placement is in the descending colon just past where it is naturally fixed down, which prevents prolapse and preserves distal bowel length for future reconstruction.
clinical9:38 ↗
Transverse colostomy should be avoided because it has higher risk of metabolic acidosis (due to greater fluid and electrolyte absorption) and higher prolapse risk.
clinical10:01 ↗
Low sigmoid colostomy should be avoided because it can interfere with future pelvic reconstruction and may require later relocation.
clinical10:12 ↗
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