ABSTRACT
Cloacal malformations are characterized by a single perineal orifice and confluence of the distal ends of the urological, genital, and gastrointestinal tracts. This represents the most complex end of the spectrum of female anorectal malformations. These rare malformations occur 1 in 25–50,000 live births. Due to this very low incidence, the majority of pediatric general surgeons and urologists will be exposed to only a few cases throughout their careers, even in a busy practice. This has led to the need to create protocols to allow for improved management. The work of Pena and Hendren to establish treatment guidelines was an essential basis for the modern understanding of these malformations [1, 2]. Separating the genital tract from urethra and emphasizing the urologic component of this surgery during cloacal repair were key foundational works [3]. Measurement of the common channel, defining the posterior sagittal anorecto-vaginourethoplasty (PSARVUP), and the total urogenital mobilization (TUM) procedure were all significant contributions to the field [4]. Recently, as technology has allowed for more complex and accurate imaging techniques, it has become clear that other aspects in the anatomical assessment are important for predicting complexity and surgical planning [5–7]. The goal of preoperative assessment is to predict in an accurate manner which cases of cloaca can be repaired with a reproducible operation, the TUM, and which cases require a more complex repair (urogenital separation) with or without the added complexity of vaginal replacement [8].
