ABSTRACT
Cloacal malformations are a rare and complex spectrum of congenital defects affecting the development of the urological, gynecological, and colorectal systems. The challenges in the reconstruction of these patients are multi-faceted. The goal of their work-up is to allow the surgical team to effectively plan and execute a strategically sound reconstruction. The main components of this plan involve accurately predicting which techniques will allow for the reconstruction of the urethra, vagina/s, and rectum in the most functional way possible. Avoiding changing the plan during surgery is very important and is now possible with proper imaging. For example, if one technique is chosen, a total urogenital mobilization, and the surgeon is then unable to mobilize the urethra to reach the perineum, the plan would then need to change, which may have significant consequences. In such a case the urethra would need to be fully mobilized and separated from the vagina, which may lead to ischemia and urethral loss. Prior to embarking on a repair the surgical team needs a clear picture of the length of the common channel, the length of the urethra, the length and position of the vagina/s, and the position of the rectum in relation to the pubococcygeal (PC) line. This information will allow the team to make sound choices prior to starting the surgery. This knowledge will also help the surgeon know whether they have the experience to do such a case or if the patient should be referred.
