الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hence, the repair of cloacal malformations remains a significant technical challenge, not only because of complex anatomical variation but also the final outcome is greatly related to the quality of life of the patient as bowel control and urinary functions are aimed in addition to safe active sexual life.
Our study was conducted on 30 patients diagnosed as Cloaca with common channel length (1-3 cm ) and (3-5cm) in Pediatric Surgery Unit, Alexandria university hospital, Aboelresh university hospital and Nationwide children Hospital, Columbus, Ohio, USA from July 2018 to December 2019.
Patients’ age ranged between 4 months and 9 years, the mean age at diagnosis in our study was 2.5 years.
Most of patients (66%) had associated renal anomalies that were mainly hydronephrosis and solitary kidney in addition to 76% of patients who suffered from associated mullerian duct defects mainly in form of vaginal septum.
Most of patients (73.6%) with common channel length (3-5 cm) were with a fair sacral ratio (>0.4 – ≤0.7) while most of patients (63.6%) with common channel length (1-3 cm) were with a good sacral ratio (>0.7).
By comparing the urethral length and common channel length by MRI and cystoscope, there was similarity of the measuring results of common channel length by using both modalities while there was significant difference between both modalities in measuring urethral length.
In spite of the presence a moderate negative correlation between common channel length and urethral length by using MRI, 33.3% of patients with common channel length 1-3 cm had short urethra length > 1.5 cm. The length of the urethra, should be added to the common channel length in determining the proper surgical technique.
According to the common channel length and urethral length measures, 14 patients were operated by PSARP & TUM while 16 patients were operated by PSARVUP & UG separation; vaginal reconstruction procedures were needed only in 16% of patients.
In patients who were operated upon by PSARP& TUM, the hospital stay ranged from 3-5 days, with postoperative complications presented in at least half of the patients, mostly in the form of anal mucosal prolapse and posterior-incision dehiscence. According to early urological function findings, there was a significant difference between patients with urethral length <1.5 cm and patients with urethral length≥1.5 cm. Spontaneous voiding was achieved in 75% of patients with urethral length≥1.5 cm in comparison to 16% of patients with urethral length <1.5 cm.
While patients who were operated upon by PSARVUP & UG separation, the hospital stay ranged from 4-7 days, with higher postoperative complications compared to patients were operated with TUM. Two thirds of patients had post-operative problems mostly in the form of vaginal stenosis. Regarding early postoperative urological findings, it was broadly similar in patients with urethral length <1.5 cm and patients with urethral length≥1.5 cm.