Comparative outcomes of posterior sagittal anorecto-vagino-urethroplasty and total urogenital mobilization in cloacal malformations: A retrospective cohort study.

OBJECTIVE

To compare the surgical and functional outcomes of PSARVUP and TUM in a contemporary cohort of patients with cloacal malformations, with particular emphasis on urological results and the influence of individual patient anatomy on these outcomes.

METHODS

A retrospective cohort study of patients with cloacal malformations who underwent definitive repair between 2020 and 2023. Inclusion criteria were confirmed cloacal malformation with prior colostomy and definitive repair by PSARVUP or TUM, whilst cases with complex sacral and spinal anomalies were excluded. Preoperative workup included cystoscopy, pelvic and spinal MRI, renal ultrasound, and voiding cystourethrography. Outcome measures included postoperative complications, ability to void spontaneously, requirements for clean intermittent catheterization (CIC), status of urinary continence, incidence of febrile urinary tract infections (UTIs), and urodynamic findings.

RESULTS

A total of 27 patients with confirmed cloacal malformations were included. Of these, 16 patients (59.3%) underwent PSARVUP and 11 patients (40.7%) underwent TUM. Within the PSARVUP cohort, wound dehiscence represented the most frequent complication compared to vaginal stenosis in TUM group. As regards recurrent frequent UTIs, the overall incidence of infection was lower in PSARVUP as compared to TUM. Overall, approximately two-thirds of all evaluated patients demonstrated abnormal findings on urodynamic assessment with neurogenic bladder patterns were the most common.

CONCLUSION

PSARVUP and TUM are effective techniques for repairing long common channel cloaca, each with distinct advantages and limitations. TUM offers an improved cosmetic outcome but can result in long-term urological complications. On the other hand, PSARVUP yields an improved functional outcome despite a more complex operative course and higher rates of vesicourethral fistulas. Longer follow-up and multicenter studies are required to refine surgical planning and optimize outcomes.