Hydrocolpos
Everything in the library about hydrocolpos — built automatically from the recorded discussions that name it
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
In-Depth Reviews
3 items
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
Summaries and takeaways+ Show
The doctors in this collection+ Show
All expert statements+ Show
Every expert statement below comes from the recorded discussions, with its speaker and moment.
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).
clinicalMarc Levitt2:38 ↗
Fetal intervention for cloaca is unlikely to be necessary; babies should typically go to term.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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).
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc Levitt17:54 ↗
Hydronephrosis in cloaca is caused by hydrocolpos pressing forward on the trigone and compressing the distal ureters where they enter the bladder.
clinicalMarc 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).
clinicalMarc 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.
clinicalMarc 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.
opinionMarc Levitt20:29 ↗
Laparoscopic approach to colostomy and hydrocolpos drainage (described by Michigan group) provides excellent visualization and is a valuable technique.
clinicalMarc 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.
clinicalMarc Levitt21:17 ↗
Urogenital sinus (single perineal opening with normal anus) requires workup for adrenal problems causing virilization, though it can occur without virilization.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc Levitt28:34 ↗
Cloaca patients benefit from collaborative multidisciplinary approach; the days of a single surgeon handling these cases alone are over.
opinionMarc Levitt30:29 ↗
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.
clinicalMarc 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.
clinicalMarc Levitt33:39 ↗
What's new+ Show