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Early Vesicostomy May Help Predict Long-Term Urinary Outcomes in Girls With Cloacal Malformation

Early Vesicostomy May Help Predict Long-Term Urinary Outcomes in Girls With Cloacal Malformation 1024 611 Lauren Dembeck
Molly Fuchs, MD, chief of Urology at Nationwide Children's, wearing scrubs and a white coat standing in a hospital hallway.

The need for vesicostomy in infancy may help identify girls with cloacal malformation who are at greater risk for impaired bladder function, chronic kidney disease, and future reconstructive surgery.

 

Girls born with cloacal malformation who require a vesicostomy in infancy may be less likely to achieve independent voiding and more likely to experience long-term urinary and renal complications, according to a study published in the Journal of Pediatric Surgery.

Researchers at Nationwide Children’s Hospital conducted the retrospective study including 159 patients with cloacal malformation treated between 2013 and 2024. Cloacal malformation is a rare congenital condition in which the rectum, vagina, and urinary tract converge into a common channel and drain through a single opening.

In infancy, some patients require a vesicostomy, a surgical opening between the bladder and abdominal wall that allows urine to drain freely and protects the bladder and kidneys when adequate drainage cannot otherwise be achieved.

“We do fewer vesicostomies now than we did in the past because we are more comfortable managing these children with catheterization of the common channel,” says Molly E. Fuchs, MD, pediatric urologist at Nationwide Children’s and senior author of the study. “But sometimes, a vesicostomy is needed and it might be the best way to protect the bladder and kidneys.”

Among the study population, 73 patients (46%) underwent neonatal vesicostomy. Compared with patients who did not require the procedure, these children were more likely to have longer common channels, shorter urethras, hydronephrosis, hydrocolpos, and a solitary kidney, suggesting that vesicostomy use frequently reflected more severe underlying anatomy.

At follow-up, 11.4% of patients in the vesicostomy group were dry and voiding voluntarily, compared with 66.2% of those who did not undergo vesicostomy. Patients who required vesicostomy were also more likely to require clean intermittent catheterization, bladder augmentation, and a catheterizable channel. Chronic kidney disease was present in 34.3% of the vesicostomy group compared with 7.0% of the comparison group.

“The vesicostomy itself is probably not what is causing these outcomes,” Dr. Fuchs says. “Rather, there were likely characteristics of that child’s anatomy and bladder function at birth that made the vesicostomy necessary, and those same factors may affect their ability to void independently later.”

The findings may therefore provide clinicians with another early indicator of long-term risk, particularly when historical operative or anatomic information is incomplete.

For families, Dr. Fuchs says the greatest value may be setting realistic expectations while emphasizing that continence is only one component of successful long-term care.

“I never want to blindside a family later by telling them their child may need catheterization or another operation when they were expecting normal voiding,” she says. “Our first priorities are safety and preserving kidney health. This gives us another piece of information we can use to prepare families for what their child may need over time.”

The researchers emphasize that the retrospective findings do not establish a causal relationship between vesicostomy and poorer outcomes. The team hopes to build on existing collaborations with other centers to compare outcomes across institutions and better understand how underlying anatomy and differences in early management contribute to long-term bladder and renal function.

 

Reference

Bain A, Tillman A, Sion A, Read M, Chen R, Rachwal B, Bricker J, Thomas E, Jayanthi VR, Wood RJ, DaJusta DG, Fuchs ME. Does the need for early cutaneous vesicostomy correlate with poor urinary outcomes in girls with cloacal malformation? J Pediatr Surg. 2026 Aug;61(8):163230. doi: 10.1016/j.jpedsurg.2026.163230.

About the author

Lauren Dembeck, PhD, is a freelance science and medical writer based in New York City. She completed her BS in biology and BA in foreign languages at West Virginia University. Dr. Dembeck studied the genetic basis of natural variation in complex traits for her doctorate in genetics at North Carolina State University. She then conducted postdoctoral research on the formation and regulation of neuronal circuits at the Okinawa Institute of Science and Technology in Japan.

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