The Mullerian Black Box: Predicting and defining Mullerian anatomy in patients with cloacal abnormalities and the need for longitudinal assessment

Retrospective study of 36 cloacal malformation patients found 83% had defined Mullerian anatomy through preoperative imaging and intraoperative assessment, with vaginal/uterine duplication most common (63%). Vaginoscopy proved superior to ultrasound, MRI, and cloacagram for predicting anatomy. 39% require longitudinal follow-up for reproductive potential and obstruction risk assessment after puberty.