The postoperative renal function of persistent cloaca patients treated by posterior sagittal anorecto-urethro-vaginopalsty: results of a nationwide survey in Japan
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In brief
In brief
Nationwide Japanese study of 103 persistent cloaca patients post-PSARUVP found 45.6% developed reduced renal function (CKD Stage ≥2), with vesicoureteral reflux identified as the primary modifiable risk factor. Early VUR detection and aggressive bladder management may preserve long-term kidney function in this complex patient population.
- 45.6% of persistent cloaca patients post-PSARUVP develop chronic kidney disease (Stage ≥2), indicating significant long-term renal risk.
- Vesicoureteral reflux is a key modifiable risk factor—significantly associated with renal function decline, UTIs, and bladder dysfunction.
- Early VUR assessment and aggressive bladder management are critical to preserving renal function in persistent cloaca patients.
- Hydrocolpos and renal anomalies show trends toward renal decline, warranting close prenatal and postnatal monitoring.
- Vesicostomy use correlates with worse renal outcomes, possibly reflecting disease severity rather than causation.
Written by the GCMD Library team from the article.
Abstract
Purpose
We investigated the postoperative renal function in persistent cloaca (PC) patients who underwent posterior sagittal anorecto-urethro-vaginopalsty (PSARUVP) and factors influencing the renal functional outcomes.
Methods
A questionnaire survey was distributed to 244 university and children’s hospitals across Japan. Of the 169 patients underwent PSARUVP, 103 patients were enrolled in the present study. Exclusion criteria was patients without data of renal prognosis.
Results
The present study showed that renal anomalies (p = 0.09), vesicoureteral reflux (VUR) (p = 0.01), and hydrocolpos (p = 0.07) were potential factors influencing a decline in the renal function. Approximately half of the patients had a normal kidney function, but 45.6% had a reduced renal function (Stage ≥ 2 chronic kidney disease: CKD). The incidence of VUR was significantly higher in the renal function decline (RFD) group than those in the preservation (RFP) group (p = 0.01). Vesicostomy was significantly more frequent in the RFD group than in the RFP group (p = 0.04). Urinary tract infections (p < 0.01) and bladder dysfunction (p = 0.04) were significantly more common in patients with VUR than in patients without VUR. There was no association between the VUR status and the bowel function.
Conclusions
Prompt assessment and treatment of VUR along with bladder management may minimize the decline in the renal function.