ABSTRACT
A 25-year-old female with a history of a complex cloaca comes to your clinic. She underwent cloacal reconstruction with a posterior sagittal anorectovaginourethroplasty (PSARVUP) as a baby and subsequently underwent a redo of her repair with partial vaginal replacement with rectum several years later due to an inadequate perineal body and introital stenosis. She underwent a Malone appendicostomy at age 5 to provide for antegrade access for flushes. Over time, she continued to require more concentrated and voluminous daily flushes to empty. The flush volume and additives were being increased by the nursing team regularly and the flush was taking longer than an hour and a half. Her Malone leaks stool 1 to 2 times per week. She presents to you for evaluation for help with improving her bowel management regimen. Her Malone flush currently is 200 mL saline, 30 mL glycerin, and 30 mL Castile soap, then 200 mL saline 10 minutes after administration. She also takes Colace 100 mg daily. She continues to experience stool accidents daily and prolonged emptying. Her urological history includes chronic kidney disease (CKD) stage 1–2, bladder and kidney stones, hydronephrosis, and bilateral vesicoureteral reflux. She catheterizes per urethra and is dry between cathing.
