Further experience in reconstructive surgery for cloacal anomalies.

This paper describes 13 more cases of urogenital sinus malformation with an anorectal anomaly, usually rectal atresia with rectovaginal fistula. It is vital to define the anatomy precisely in these cases to guide the operative approach best suited for repair. Neonatal loop colostomy is needed in most. Intermittent catheterization of the bladder and/or urine-filled vagina via the urogenital sinus can allow temporizing until the child is old enough for a definitive reconstruction. Various urinary diversions are best avoided if possible, except possibly a simple temporary suprapubic cystostomy. It is best to complete the reconstructive operation, in a single procedure which is often long and complex. Preliminary AP pullthrough of the colon without repair of the genitourinary aspect of the problem can lead to urinary tract stasis and serious obstructive uropathy. A satisfactory functional and anatomic solution is possible in most of these girls.