AUA Summit - What are Cloacal Abnormalities?

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What are Cloacal Abnormalities?

As a baby develops, three openings normally form for the intestinal, genital and urinary tracts. In early stages of pregnancy, these three openings are together in a sac called "Cloaca." They then separate from each other to form the anus, vagina and urethra. In rare cases, this area may develop incorrectly. A "persistent cloaca" may form if these tracts fail to separate from each other. This is when the intestinal, genital and urinary tracts open into one common cavity, with one opening on the skin where the vaginal opening would be. A newborn with this defect has no visible anus (the opening where feces leave the body). Everything else on the outside usually looks normal. Cloacal anomalies can affect 1 in every 50,000 babies.

Symptoms

In some cases the three tracts come together at a low point close to the skin. Since it is close to the skin, the “common channel” is short. These girls usually pass urine without problems.

In more severe cases the three tracts come together at a high point. Thus, the common channel is long, so draining urine and feces is more difficult. Urinary tract infections are common.

Other issues:

  • The clitoris may look like a penis (gender confusion)
  • There may be more than one vagina and cervix
  • The vagina can be obstructed leading to an abdominal swelling
  • The anus may be malformed
  • There may be other problems with the ureters and kidneys
  • The spinal cord can be abnormal
  • The heart can have structural defects
  • Limbs can be deformed

Diagnosis

At birth the doctor will see that the newborn has only one opening.

The tests to confirm the diagnosis may include:

Ultrasound

An ultrasound is done to see swelling in the bladder, vagina and rectum. It will also show if there is a buildup of urine in the kidneys and ureters. This can happen when urine stays in the bladder and can't drain. Kidney problems can happen in 60 – 80% of cases.

MRI

Lastly, an MRI of the pelvis and spine will be done. This will look for spinal defects. The heart can also be checked by echocardiogram.

Endoscopy and X-rays

The surgeon will examine the area with an endoscope. In addition, dye is placed into the common channel and an X-ray is taken. This procedure and the x-rays will usually define the anatomy and guide the surgeon in determining the best surgery for your child.

After Treatment

Many parents have questions about their child’s ability to control urine or feces after surgery. This depends to a large extent upon whether the spina cord is normal. Some children will be able to pass urine normally. Some will require the use of a catheter. Most children will not leak stool but many need to use enemas. Most children will be able to have a normal and enjoyable sex life.

Updated March 2024. 


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