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Dr. Kat Ford - Best of the Best in Pediatric Surgery 2025
With Dr. Kat Ford
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Cloaca 33 items
Chapter 1 of 9 · Fundamentals
Introduction
Introduction of Dr. Kat Ford and presentation topic
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What the experts said
A cloaca is a defect in which the rectum, one or two vaginas, and the urinary tract converge into a common channel, and opening in the perineum.
Common channel length is split into two types: long (more than 3 centimeters) and short (less than 3 centimeters), with the 3 centimeter cutoff being described as the difference between simple and complex cloaca.
The common channel length classification has reconstructive implications and was introduced by both Pena and Hendrin in the 1990s.
When the common channel is less than 3 centimeters, the great majority can be repaired using a posterior sagittal approach only.
The evidence behind the correlation between common channel length and functional outcome is limited.
The study included 55 patients after excluding 4, with complete bowel function scores on 38 patients and common channel lengths on 50 patients, with final analysis conducted on 38 patients.
The mean age at definitive reconstruction was 6 months, and mean age at outcome analysis was 73 months.
As per the Rintala bowel function score, a score of more than 17 is interpreted as normal.
The median bowel function score for this cohort was 8, with an interquartile range of 5 to 15.
16% of the cohort had a bowel function score of greater than or equal to 17 out of 20.
The median common channel length was 2.5 centimeters.
There was no difference in incidence of associated spinal anomaly or developmental delay between the short and long common channel groups.
More patients were on transanal irrigation in the long common channel group, despite the bowel function score being the same between the two groups.
When common channel length was analyzed as a continuous variable and plotted against bowel function score, no correlation was observed.
ROC analysis found no discriminatory value of common channel length in prediction of bowel function.
A trend in developmental delay and presence of spinal anomaly were associated with worse bowel function, however this did not reach statistical significance.
There was a clear association between age and bowel function, with older children doing better.
In multivariable linear regression with bowel function score as the dependent variable, common channel length and the presence of spinal anomaly were not associated with bowel function.
Older age and less deprived socioeconomic groups were associated with better bowel function in multivariable analysis.
Of the 47 patients on whom urinary outcomes were available, 40% reported urinary continence and 32% were performing clean intermittent catheterization.
Common channel length alone is inadequate for guiding prognosis in cloacal malformations.
The presence of developmental delay was associated with worse bowel function in multivariable analysis.
On univariate analysis, there was no association between urinary incontinence and common channel length.
On multivariable linear regression for urinary outcomes, age was the only factor associated with urinary incontinence.
In the UK, socioeconomic status is measured using a postcode-based measurement which incorporates several variables and is fairly reliable but has its issues.
Socioeconomic group was not an independent variable affecting outcome in itself, but when other factors were removed, it became a dominant variable.
Both Pena and Levitt report that short common channel length cloacas are often associated with less comorbidities, which contribute to functional outcome.