Does the need for early cutaneous vesicostomy correlate with poor urinary outcomes in girls with cloacal malformation?

INTRODUCTION

In the neonatal period, children with cloacal malformation may require bladder drainage with a vesicostomy. Little is known if vesicostomy creation in these patients affects long-term urinary outcomes, specifically volitional voiding rates and continence rates. Our objective was to determine whether the requirement of vesicostomy at birth is a predictor of worse urinary outcomes for patients with cloacal malformation.

METHODS

A retrospective review was performed of all patients with cloacal malformations being managed at a single institution from 2013 to 2024. Anatomic details and clinical outcomes were collected and compared between patients who required a vesicostomy in the neonatal period versus those who did not.

RESULTS

A total of 159 patients were included. Patients with a vesicostomy were more likely to have a long common channel (54.8% vs 15.1%, p < 0.0001), higher rates of hydronephrosis (79.2% vs 44.7%, p = 0.0007) and hydrocolpos (87.5% vs 41.3%, p < 0.0001) at birth. Only 11.4% of patients in the vesicostomy cohort achieved volitional voiding and were dry at last clinic encounter, compared to 66.2% in the no vesicostomy cohort (p < 0.0001). Patients in the vesicostomy cohort had a higher likelihood of developing chronic kidney disease, requiring bladder augmentation and relying on clean intermittent catheterization to achieve continence.

CONCLUSION

The need for a vesicostomy at birth in those with cloacal malformation is associated with decreased likelihood of achieving volitional voiding and worse renal function. This information will be helpful for counseling families on long-term urinary outcomes for these patients.