Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Collaborative work: Complex Pediatric Anorectal Malformations 2017
Dr. Todd Ponsky · 23 min · Published Jun 2017
Podcast
Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison
43 min · Published Dec 2016
Podcast
Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison
43 min · Published Dec 2016
Podcast
Colorectal Quiz Episode 29: Female ARM-Post Op Management
25 min · Published Mar 2022
Video
Cloaca - Long Common Channel
14 min · Published Nov 2018
Podcast
Colorectal Quiz: Episode 50 - 16th Annual European Pediatric Colorectal and Pelvic Reconstruction Conference, Stockholm, Sweden, October 2025 - What did we learn?
24 min · Published Mar 2026
Only a few other public items share this expert — go deeper there →
Video
Pediatric Surgical Oncology Research Collaborative (PSORC): Studying Rare Pediatric Tumors
56 s · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Pooling Patients to Study Rare Pediatric Tumors: An Introduction to PSORC
56 s · Published May 2026
Video
The fetal frontier: A review of current and emerging fetal therapies for genetic diseases
44 s · Published May 2026
Video
Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients
1 min · Published May 2026
What the experts said
Intraoperative assessment of Müllerian structures can be accomplished by gently cannulating the fallopian tube with a 3 or 3.5 French feeding tube (with additional holes removed) and instilling saline to test patency
Girls will not start menstruation until about 1.5 to 3 years after the onset of breast development
Complete metadata for medical education content includes title, description, summary, keywords, duration, content type, specialty area, target audience level, and language
About 30% of vaginal switch cases had distal vaginal tissue with poor blood supply requiring reoperation
Vaginal switch procedure is only useful in specific anatomic setup with widely separated hemi-uteri
In 60 vaginal switch cases (58 cloacas, mean common channel 5.2 cm), the procedure was performed in only 10% of 568 total cloaca patients
Of 60 vaginal switch patients, 27 (45%) acquired vaginal stenosis, 11 required vaginal replacement, 6 required introitoplasty, and 4 required incidental oophorectomy
Native vagina is always superior to graft tissue for vaginal reconstruction
In 134 neovaginal replacements, introital stenosis occurred in 8-18% depending on bowel segment used
Neovaginal prolapse ranged from 8% to 20% depending on bowel segment used
Only patients with rectal neovagina complained of mucus secretion; colonic neovagina patients did not have significant mucus concerns
Buccal mucosa grafts require stent placement ("rocket ship") for approximately one week with patient at bed rest
Buccal mucosa is primarily used for augmentation vaginoplasty in post-pubertal patients, not for bridging wide open spaces
Cincinnati Children's team does not include vaginal dilation at the time of neovaginal reconstruction, even with bowel replacement
Examination should be performed after onset of puberty and menstruation but before sexual debut
Introitoplasty should be performed after puberty when native perineal tissue is more pliable from estrogen stimulation and heals better
For patients with fibrotic, non-elastic vagina in entire length who have redundant rectum, rectal patch from posterior sagittal approach can allow sexual activity without major vaginal replacement
Rectal patch technique is particularly appropriate for patients already performing daily enemas who may not rely on rectal musculature for bowel control
From 82 survey responses of patients ≥18 years, there were 40 pregnancies in 25 patients with 35 live births, 1 neonatal death, 22 C-sections, 7 vaginal deliveries, and 5 miscarriages
All 9 cloaca patients in the pregnancy cohort were delivered by C-section
Women diagnosed with cloaca were more likely to have additional gynecologic conditions (PID, infertility, endometriosis, PCOS) than women with other anorectal malformation diagnoses
Patients with neovaginal graft should not be considered for vaginal delivery
Patients catheterizing via Mitrofanoff or using enemas daily may have more risk from C-section than vaginal delivery
Laparoscopy allows assessment and mobilization of Müllerian structures when they cannot be accessed from the perineum
Laparoscopic dissection of vagina from posterior bladder and rectum can minimize incision size during definitive procedure
41% of patients with cloacal anomaly develop pelvic collection of menstrual blood requiring reoperation
Of 23 reported neovaginal malignancies, mean time to development was 19.2 years overall and 24 years for bowel segment cases