Krstic Z D, Lukac M, Lukac R, Smoljanic Z, Vukadinovic V, Varinac D
Department of Pediatric Surgery, University Children's Hospital, Tirsova 10, 11000 Belgrade, Serbia, Yugoslavia.
Pediatr Surg Int. 2001 May;17(4):329-33. doi: 10.1007/s003830000522.
From 1989-1998 14 patients were treated with cloacal anomalies: 5 typical cloacas (PC), 5 posterior cloacas, and 4 cloacal exstrophies (CE); 12 underwent surgery. Four typical cloacas were resolved with posterior sagittal anorectovagino-urethroplasty (PSARVUP), whereas in the 5th total urogenital mobilization (TUM) was used. Three PCs were managed with transanorectal TUM and 2 with anterior TUM without opening the anal canal and rectum (without a protective colostomy). Two CEs were treated with atypical procedures. Two patients with CE died without surgery and 2 died after surgery due to complex associated anomalies. During postoperative follow-up of 1-8 years, 5 children had voluntary bowel movements and no soiling while the others had soiling with or without enemas; 1 had stress incontinence; 3 were on clean intermittent catheterization due to neurogenic bladder and were dry. PSARVUP provides a satisfactory result if there is no sacral anomaly. TUM makes this operation easier to perform. In patients with a PC it is sometimes possible using TUM to separate the urinary from the genital tract and remove the accessory urethra without opening the anus and rectum.
1989年至1998年期间，14例泄殖腔畸形患者接受了治疗：5例典型泄殖腔（PC）、5例后泄殖腔和4例泄殖腔外翻（CE）；12例接受了手术。4例典型泄殖腔通过后矢状位肛门直肠阴道尿道成形术（PSARVUP）得到解决，而第5例则采用了全泌尿生殖系统游离术（TUM）。3例PC采用经肛门直肠TUM治疗，2例采用前路TUM治疗，未打开肛管和直肠（未行保护性结肠造口术）。2例CE采用非典型手术治疗。2例CE患者未手术死亡，2例术后因复杂的相关畸形死亡。在1至8年的术后随访中，5名儿童有自主排便且无便污，而其他儿童有便污，有或没有灌肠辅助；1例有压力性尿失禁；3例因神经源性膀胱接受清洁间歇性导尿，且无尿失禁。如果没有骶骨异常，PSARVUP可提供满意的结果。TUM使该手术更易于实施。对于PC患者，有时使用TUM可以在不打开肛门和直肠的情况下将泌尿系统与生殖道分离并切除副尿道。
