Cloaca - Long Common Channel

Common channel length measured 6 cm on cystoscopy, 5 cm on cloacogram (measurements sometimes differ between modalities).

In high common channel cloacas, the common walls between rectum, vagina, and bladder are not long and are easier to separate abdominally than to search for posterior sagittally.

Saline perturbation is used intraoperatively to assess patency of the reproductive tract in cloacal cases.

When one hemivagina/hemiuterus is well developed and the other is atretic, it may be advantageous to retain the well-developed side and remove the atretic side to avoid menstrual complications and preserve childbearing potential.

Using the rectum as vaginal replacement may change a potentially fecally continent patient into an incontinent one by removing the rectal reservoir.

Rectum should be used for vaginal replacement only in patients who are not expected to be fecally continent (e.g., tethered cord, short sacrum).

In Dr. Pena's early cases using rectum as vagina in vestibular fistula patients with absent vagina, long-term follow-up showed less than optimal bowel control.

Preservation of the rectum is extremely important in patients with good functional prognosis (good sacrum, no tethered cord, good malformation).

The rectum is a natural reservoir; removing it in anorectal malformation patients will most likely result in incontinence because patients cannot tolerate constant stool passage when colon is connected directly to perineum.

Descending colon is increasingly used for vaginal replacement because the vascular arcades are favorable for preserving blood supply.

Dr. Pena has seen approximately 65 cases that came operated from other institutions with a diagnosis of intersex at birth due to phallic-appearing anatomy, all of which were chromosomally normal females with cloacas.

Dr. Pena has never seen a patient with intersex and a cloaca coexisting.

A patient with a pseudophallus and single perineal orifice can be differentiated from adrenal hyperplasia by palpation: true corpora are palpable in adrenal hyperplasia, whereas in cloaca the structure is folded skin.

The folded skin of the pseudophallus in cloacal patients can be used to facilitate vaginal reconstruction.

Families agonize during the 2-3 weeks that doctors spend trying to make an intersex diagnosis in cloacal patients with phallic structures.