Enhancing Urethral Meatus Creation in Cloacal Malformations: A New Technique

In the previous technique for cloacal repair, the urethra and vagina were brought up to the introitus and separately anastomosed, resulting in poor definition of the vaginal vestibule and labia, often with skin separation between the urethra and vagina.

In the new technique, the urethral meatus is positioned slightly recessed and posterior to the clitoris in a more orthotopic position, which rebuilds the vaginal vestibule.

Key components of the technique include careful dissection and reconfiguration of the anterior and posterior urethra to form a patent orthotopic meatus that is slightly recessed, in addition to creating well-defined labia minora.

In patients who underwent cloacal repair with urogenital sinus separation and vaginal and anorectal pull-through, the common channel becomes the urethra.

The first step is to recess the urethromeatus to a more orthotopic location by opening the urethromeatus and performing a urethromeattoplasty if necessary.

To recreate and build the vaginal vestibule, the vagina is slightly tubularized and then re-approximated to the neourethral meatus at its inferior aspect.

A retrospective case series included 50 patients with cloacal anomalies who underwent primary cloacal repair between 2020 and 2024.

Of 50 cloacal anomaly patients, 24 underwent urogenital sinus separation with vaginal and anorectal pull-through, and 17 underwent total urogenital mobilization.

The urethromiattoplasty technique was applied to 6 patients who underwent urogenital sinus separation and 5 patients who underwent total urogenital mobilization.

On follow-up, all patients who underwent the new urethromeatoplasty technique had satisfactory cosmetic results and successful neoatus creation with minimal scarring and a well-positioned urethral meatus.

There were no instances of stenosis or fistula in patients who underwent the new urethromeatoplasty technique.

Among 11 patients who underwent the new technique, 1 required clean intermittent catheterization, 3 underwent vesicostomy for bladder management, and 7 did not require assisted bladder emptying.

This novel urethromattoplasty technique offers a promising option for cloacal anomaly repair, combining functional success with improved cosmetic outcomes.