Cloacal Endoscopy

Persistent cloaca is one of the most complex innerectal anomalies. In this condition, the length of the common channel is directly related to the complexity of the reconstruction. Cloacal endoscopy is therefore a very important component of the workup of these patients. The endoscopy is performed using a pediatric cystoscope. This video demonstrates examples of short and long common channels identified on endoscopy. In this case, a short, common channel was clearly identified. All three orifices, urethra, vagina, and rectum, are identified within a short distance of the perineum. This view shows a junction of the urethral and vaginal orifices. This view shows the vaginal and rectal orifices clearly. A longitudinal septum resulting in two hemivaginas is identified, as is commonly seen in persistent cloaca. In this case, the common channel measured approximately 2.5 centimeters. This video shows an endoscopy of a long common channel. The first bifurcation is seen approximately 3 centimeters from the perineum. The common channel continues proximately, and a trifurcation is seen another 3 centimeters more proximal to the first bifurcation. The trifurcation is formed by two hemivaginas anteriorly and the rectum posteriorly. Each hemivagina terminates in a cervical os. The rectal opening into the cloaca is seen posterior to the reproductive tract. As the cystoscope is withdrawn, the urethral orifice again comes into view. Advancing the scope through that orifice leads into the bladder neck and urinary bladder. In this case, the common channel measured approximately 6 centimeters.