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Oral Presentation - 39
Management and long-term outcomes of cloaca patients: Quality of life, intestinal and urinary function at a Latin American pediatric center
Daniela Moreno, Laura Rodriguez, Jose Cely, Juan Valero, Fernando Fierro
Universidad Nacional de Colombia, Fundación Hospital pediátrico La Misericordia
Purpose: Present the management experience of cloaca patients from 2008 to 2022, evaluating intestinal and urinary function and long-term quality of life.
Method: Retrospective case series of patients with cloaca surgically corrected between 2008 and 2022. Follow-up assessed intestinal and urinary function plus quality of life using the PEDsQL scale. Ethics committee approval was obtained.
Results: 23 patients were included. 52.1% had a short common channel, 47.9% a long channel. In the short channel group (11 patients), 81.8% had associated malformations, mainly renal (72.7%). Sacral ratio average was 0,5. Total urogenital mobilization via posterior sagittal approach was performed in 63.6%; 36.4% needed an abdominal approach. Follow-up was performed in 90.9%. Constipation affected 63.6%, with 60% adherence. Fecal incontinence occurred in 54.5%, 33.3% were accident-free. Urinary incontinence was 45.5%, and 18.1% required catheterization. PEDsQL was applied to 9 patients; average score was 67.92 (parent report) and 85.87 (patient report)
In the long channel group (12 patients), 91.6% had associated anomalies, mainly renal (83.3%). Sacral ratio average was 0,5. Urogenital mobilization with abdominal approach was done in 58.3%; vaginal replacement in 16.7%. Follow-up included 83.3% patients. Constipation affected 50%, with 35% adherence. Fecal incontinence was 50%, 20% were accident-free. One patient had a Malone procedure. Urinary incontinence was 66.6%, 30.2% needed catheterization. PEDsQL was applied to 8 patients; average score was 68.91 (parent report) and 68.66 (patient report)
Conclusion: Cloacal malformation is a rare, complex anomaly often linked to other defects (mainly renal). Surgery requires multidisciplinary care, making specialized centers essential. Long-term follow-up shows half have fecal incontinence; urinary continence is more common with long channels. Quality of life improves in milder cases.