Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy.
Pediatric Surgery, University of Genoa, DINOGMI, Largo Paolo Daneo 3, 16132, Genoa, GE, Italy.
Pediatr Surg Int. 2023 Aug 16;39(1):247. doi: 10.1007/s00383-023-05539-2.
Urological management of Cloacal Malformation (CM) focuses on preserving renal function and continence. Study aim was to analyze urinary and intestinal outcomes in CM patients, considering the length of common channel (CC) and presence of occult spinal dysraphism (OSD).
Retrospective review of CM treated at our institution by a multidisciplinary team from 1999 to 2020. Patients with follow-up < 2.5 years were excluded. Length of CC, renal function, urinary and bowel outcomes, presence of associated anomalies (especially OSD) were evaluated.
Twenty patients were included, median age at follow-up: 8 years (4-15). A long CC > 3 cm was described in 11 (55%). Chronic kidney disease was found in 3 patients. Urinary continence was achieved in 8/20 patients, dryness (with intermittent catheterization) in 9/20. Fecal continence was obtained in 3/20, cleanliness in 14 (under bowel regimen). OSD was present in 10 patients (higher prevalence in long-CC, 73%). Among OSD, 1 patient reached fecal continence, 7 were clean; 2 achieved urinary continence, while 6 were dry.
Length of CC and OSD may affect urinary and fecal continence. An early counseling can improve outcome at long-term follow-up. Multidisciplinary management with patient centralization in high grade institutions is recommended to achieve better results.
尿道下裂畸形（CM）的泌尿外科治疗重点在于保护肾功能和控尿功能。本研究旨在分析 CM 患者的尿便功能预后，并探讨共同通道（CC）长度和隐性脊柱裂（OSD）的存在对其的影响。
对 1999 年至 2020 年期间，由多学科团队在本机构治疗的 CM 患者进行回顾性分析，排除随访时间<2.5 年的患者。评估 CC 长度、肾功能、尿便功能，以及合并畸形（特别是 OSD）的情况。
共纳入 20 例患者，随访时的中位年龄为 8 岁（4-15 岁）。11 例（55%）患者存在 CC 长度>3cm，3 例患者存在慢性肾脏病。20 例患者中，8 例获得尿控，9 例通过间歇性导尿实现控尿，3 例获得粪控，14 例通过肠道管理实现粪便清洁。10 例患者存在 OSD（长 CC 患者中 OSD 发生率更高，为 73%）。在存在 OSD 的患者中，1 例获得粪控，7 例实现清洁；2 例获得尿控，6 例实现控尿。
CC 长度和 OSD 可能影响尿便控控能力。早期咨询可以改善长期随访的结局。建议多学科管理，将患者集中在高等级机构，以获得更好的结果。
