Enhancing Urethral Meatus Creation in Cloacal Malformations: A New Technique

In the previous technique, the urethra and vagina were brought up to the introitus and separately anastomosed, resulting in poor definition of the vaginal vestibule and labia, often with skin separation between the urethra and vagina.

In the new technique, the urethral meatus is positioned slightly recessed and posterior to the clitoris in a more orthotopic position, which rebuilds the vaginal vestibule.

Key components include careful dissection and reconfiguration of the anterior and posterior urethra to form a patent orthotopic meatus that is slightly recessed, in addition to creating well-defined labia minora.

In cloacal repair patients who underwent urogenital sinus separation and vaginal and anorectal pull-through, the common channel becomes the urethra.

The first step is to recess the urethromeatus to a more orthotopic location by opening the urethromeatus and performing a urethromeattoplasty if necessary.

To recreate and build the vaginal vestibule, the vagina is slightly tubularized and then re-approximated to the neourethral meatus at its inferior aspect.

A retrospective case series included 50 patients with cloacal anomalies who underwent primary cloacal repair between 2020 and 2024.

Of the 50 patients, 24 underwent urogenital sinus separation with vaginal and anorectal pull-through, and 17 underwent total urogenital mobilization.

The urethromiattoplasty technique was applied to 6 patients who underwent UG separation and 5 patients who underwent TUM.

On follow-up, all patients had satisfactory cosmetic results and successful neoatus creation with minimal scarring and a well-positioned urethral meatus.

There were no instances of stenosis or fistula in the case series.

1 patient required clean intermittent catheterization.

3 patients underwent vesicostomy for bladder management.

7 patients did not require assisted bladder emptying.