Close
Enter your
text here

Surgical Repair of Cloacal Malformation Does Not Worsen Bladder Function

Surgical Repair of Cloacal Malformation Does Not Worsen Bladder Function 1024 683 Mary Bates, PhD

The complexity of the malformation, more than the surgical approach, determines post-operative urodynamics.

Approximately 90% of girls with cloacal malformation exhibit some degree of bladder dysfunction. While associated conditions can impact bladder dynamics, the complex surgery required to repair cloacal malformation has also been hypothesized to cause bladder dysfunction.

Strategies to repair cloacal malformation in girls involve one of two surgeries: urogenital separation (UGS) or total urogenital mobilization (TUM). At Nationwide Children’s, physicians decide on the best approach for each patient with an algorithm that takes into consideration both the length of the common channel and the urethra. Generally, TUM is recommended for short common channel cloacal malformations and UGS is the approach recommended for longer common channels and shorter urethral lengths.

“There have been concerns that the surgery itself could affect bladder function,” says Daniel DaJusta, MD, a pediatric urologist at Nationwide Children’s. “It was not known if these kids’ bladders were problematic to begin with, or if the surgery was causing them to be incontinent.”

In a new study, Dr. DaJusta and colleagues evaluated if either of the surgical procedures alters bladder dynamics in girls with cloacal malformation. Led by pediatric urologist Molly Fuchs, MD, the team studied pre- and post-operative urodynamics tests from about 50 patients who had undergone either UGS or TUM at Nationwide Children’s between 2015 and 2022.

The researchers found that neither surgery had a significant effect on bladder function. The main factor influencing urodynamics was the length of the common channel, with long common channels (and thus, more complex malformations) associated with worsening post-operative bladder function. In addition, a patient’s spinal status may also impact their ability to achieve urinary continence, says Dr. DaJusta.

“The major clinical implication is that we clinicians can tell parents that the surgery itself is safe and not the main cause of any bladder problems,” says Dr. DaJusta, who is also a clinical assistant professor of urology at The Ohio State University College of Medicine.

“These surgeries are done within the first year of life, too early for us to be able to predict the long-term bladder function of a patient. But we can tell parents that irrespective of the surgery that we perform, it is not going to affect their child’s ability to achieve continence.”

 

Reference:

Fuchs ME, Srinivas S, Quintanilla Amoros R, Jayanthi VR, Wood RJ, Dajusta DG. The effect of surgical reconstruction on bladder function in cloacal malformation: A study of urodynamics. J Pediatr Urol. 2024 Jul 10:S1477-5131(24)00356-5. doi: 10.1016/j.jpurol.2024.07.002. Epub ahead of print.

 

About the author

Mary a freelance science writer and blogger based in Boston. Her favorite topics include biology, psychology, neuroscience, ecology, and animal behavior. She has a BA in Biology-Psychology with a minor in English from Skidmore College in Saratoga Springs, NY, and a PhD from Brown University, where she researched bat echolocation and bullfrog chorusing.

You might also like