Collection
Built automatically
From across the library
Not curated by a person
Hydrocolpos
Compiled from across the library · built automatically
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
If a patient is going to the operating room for colostomy within 24-48 hours and has hydrocolpos, the most sensible and safest approach is to drain it at the time of colostomy — Richard, Case Presentations Part I: Cloaca and Complex ARMs 2015 · 12:13
Case Presentations Part I: Cloaca and Complex ARMs 2015
Watch →
Dr. Belinda Hsi Dickie, surgical director of the Hemangioma and Vascular Malformations Center, and Dr. Lesley Breech, Division Director of Pediatric and Adolescent Gynecology, present cloaca cases for discussion.
video45:15 · Jan 2019
Initial workup includes ultrasound for hydronephrosis and kidney number, spinal ultrasound for tethered cord, plain X-ray of spine for hemivertebrae and sacral quality, and echocardiogram at most centers. — Marc Levitt, Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison · 9:59
Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison
Listen →
Marc Levitt, MD discusses Cloaca with Todd Ponsky, MD and Aaron Garrison, MDEdited by Ian C Glenn, MD and Sophia Abdulhai, MDDr. Levitt is surgical director of the Center for Colorectal and Pelvic Reconstruction as well as program director
podcast43:47 · Jan 2019
Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison
Listen →
Marc Levitt, MD discusses Cloaca with Todd Ponsky, MD and Aaron Garrison, MDEdited by Ian C Glenn, MD and Sophia Abdulhai, MDDr. Levitt is surgical director of the Center for Colorectal and Pelvic Reconstruction as well as program director
podcast43:47 · Dec 2020
ERN eUROGEN ARM Webinar Series: Management of Cloacal Malformations – what is new in 2021?
Watch →
eUROGEN ARM Webinars Series, October 2021
This webinar will be presented by Dr. Marc Levitt from the Children’s National Hospital in Washington D.C.
The management of cloacal malformations, including prenatal diagnosis, newborn trea
video48:03 · Dec 2022
Expert statements from the recordings in this collection.
Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison
The most common prenatal ultrasound finding in cloaca is a pelvic mass, often representing a dilated vagina (hydrocolpos).
Marc Levitt2:38
Fetal intervention for cloaca is unlikely to be necessary; babies should typically go to term.
Marc Levitt3:56
Fetal hydrocolpos drainage has been performed at least once (case report from Japan) for massive hydronephrosis with impending renal loss, similar to bladder drainage for urethral valves.
Marc Levitt5:14
In cloaca, there is one perineal hole below the clitoris and no anus; this is not ambiguous genitalia, there is no adrenal problem, and the baby is a normal female with two normal ovaries.
Marc Levitt6:37
A urogenital sinus (single hole with normal anus present) may be associated with virilization and requires evaluation for adrenal hyperplasia and electrolyte abnormalities.
Marc Levitt6:57
To examine a newborn for cloaca, grab the labia and lift them up and out with very good lighting to see if there is a single hole or distinct urethral, vaginal, and rectal orifices.
Marc Levitt8:36
Many patients considered cloacas actually have vestibular fistulas; with better examination you can see three holes (urethra, vagina, and rectal opening in vestibule).
Marc Levitt9:03
Initial workup for cloaca includes ultrasound for hydronephrosis and kidney number, spinal ultrasound for tethered cord, cardiac auscultation, and plain X-ray of spine to assess sacrum.
Marc Levitt9:59
Intermittent catheterization of the common channel may decompress hydrocolpos, but is not reliable because the catheter may enter the urethra, right or left vagina, or rectum; success should be confirmed by ultrasound.
Marc Levitt11:14
If hydrocolpos is bilateral, open into both vaginas at the dome, remove some of the common wall (septum), and one tube will drain both sides.
Marc Levitt13:14
For vaginostomy, use an 8 or 10 French pigtail catheter (not a straight catheter) because as hydrocolpos recedes, straight catheters fall out but curled catheters do not.
Marc Levitt14:15
Vesicostomy is rarely needed in cloaca; the problem is usually hydrocolpos compressing the trigone and distal ureters, not bladder drainage. Draining the hydrocolpos relieves the ureteral obstruction.
Marc Levitt15:05
Vesicostomy is indicated only when the bladder does not drain after successful hydrocolpos decompression, which occurs in very rare circumstances with very long narrow common channels or absent urethra.
Marc Levitt16:28
Vesicostomy is also indicated in the rare circumstance of massive bilateral ureteral reflux, where decompressing the system protects the ureters until later repair.
Marc Levitt17:54
Hydronephrosis in cloaca is caused by hydrocolpos pressing forward on the trigone and compressing the distal ureters where they enter the bladder.
Marc Levitt20:11
Hydrocolpos develops because urine preferentially fills the vagina through the vaginal fistula rather than exiting the common channel, likely due to mechanical factors (steep urethral angle).
Marc Levitt18:21
Hydrocolpos fluid is typically a turbid combination of mucus and urine; maternal estrogen effect can increase mucus production and rarely cause blood in the hydrocolpos.
Marc Levitt18:48
Cystoscopy in the newborn period is not advantageous; the required scope is tiny, visualization is poor, the perineum is swollen, and it is better to minimize OR time in newborns.
Laparoscopic approach to colostomy and hydrocolpos drainage (described by Michigan group) provides excellent visualization and is a valuable technique.
Marc Levitt20:49
For massive hydrocolpos extending above the umbilicus, use a lower midline incision to access the dome, and consider a tubeless vaginostomy sutured to the abdominal wall like a G-tube.
Marc Levitt21:17
Urogenital sinus (single perineal opening with normal anus) requires workup for adrenal problems causing virilization, though it can occur without virilization.
Marc Levitt22:28
Most urogenital sinuses can be managed with perineal urogenital mobilization without touching the rectum; high UG sinus cases may require a transrectal (Astra) approach.
Marc Levitt23:17
Definitive cloaca repair timing: perform endoscopy and cloacography at 2–3 months of age, then repair anytime thereafter within one year, ideally before 6 months if managing from birth.
Marc Levitt23:57
The two critical endoscopic measurements are common channel length (from perineum to urethral takeoff) and urethral length (from urethral takeoff to bladder neck); urethral length determines the surgical approach.
Marc Levitt25:25
Traditional classification uses 3 cm common channel length (≤3 cm straightforward, >3 cm complicated), but urethral length is equally important and not mentioned in published papers.
Marc Levitt25:27
Endoscopy can falsely suggest the rectum is reachable when it is actually a long narrow fistula with healthy rectum high in the abdomen; contrast study (cloacogram) is needed to assess this.
Marc Levitt26:21
3D cloacogram reconstruction is superior to 2D fluoroscopy; experienced surgeons answer anatomy questions more correctly with 3D imaging, and printed 3D models may be even better.
Marc Levitt28:34
Cloaca patients benefit from collaborative multidisciplinary approach; the days of a single surgeon handling these cases alone are over.
Urogenital mobilization, first described by Alberto Pena in 1996, mobilizes urethra and vagina as a unit without operating on the wall between them, eliminating the 10% urethral-vaginal fistula rate of prior techniques.
Marc Levitt32:15
Urogenital mobilization is appropriate when common channel is ≤3 cm AND urethral length above the takeoff is at least 1.5–2 cm; this leaves adequate urethral length after splitting the common channel.
Marc Levitt33:39