Clinical characteristics of children with persistent cloaca: A urological perspective

Purpose: Persistent cloaca is a rare multiple anomalous condition which involves the gastrointestinal, neurological and urogenital systems. We evaluated the clinical characteristics and urogenital anomalies of patients with persistent cloaca, and we investigated the factors that must be considered from a urological perspective. Materials and Methods: We retrospectively reviewed the medical records of 11 patients who were diagnosed with persistent cloaca at our institution during the last 7 years. Results: Nine of the 11 patients who were followed up at the urology clinic were subjected to this study. Nonspecific abnormalities, such as antenatal hydronephrosis, were noted in 5 of 9 patients. The chief complaints upon visits to the urologic clinic were recurrent urinary tract infections in 3, preoperative evaluation before neurosurgery in 3, urinary incontinence in 1, urinary retention in 1 and an elevated creatinine level in 1. The urological anomalies included 2 cases of renal agenesis and 1 horseshoe kidney. Vesicoureteral reflux was noted in 6 patients, and 4 of these patients underwent antireflux surgery. Videourodynamic study was performed in 8 patients and all of them were diagnosed with neurogenic bladder. Currently, 5 children are on intermittent catheterization, 2 have undergone vesicostomy and 2 void spontaneously. Conclusions: Most patients with persistent cloaca had urological anomalies of the upper urinary tract and neurogenic bladder. Therefore, a multidisciplinary approach for diagnosis and treatment from various departments, including the urology, pediatric surgery, neurosurgery departments is mandatory.