ESPU Congress 2018 - Abstract Book

213

11–14 APRIL, 2018, HELSINKI, FINLAND

VD-26 (VS without presentation)

CLOACAL REPAIR BY POSTERIOR SAGITTAL

ANORECTOPLASTY (PSARP) AND TOTAL UROGENITAL

MOBILIZATION (TUM)

Sami CHERIGUI

, Tariq ABBAS

, Mansour ALI

and Joao Luiz PIPPI SALLE

1) Hamad Medical Corporation-Hamad Hospital, Pediatric Surgery, Doha, QATAR - 2) Sidra Medecine, Pediatric

Urology, Doha, QATAR

PURPOSE

Persistent cloaca is a complex malformation with anomalous confluence of the urethra, vagina and

rectum sharing a common channel to the perineum. The level at which the three systems meet is

variable. The persistence of cloaca remains one of the most challenging problems in reconstructive

pediatric urology. We present a video emphasizing the main technical steps of cloacal repair by

PSARP and TUM.

MATERIAL AND METHODS

A 9 months old girl who was born with a single perineal orifice, hydrocolpos and secondary bilateral

hydronephrosis. She underwent a left divided colostomy at birth and was kept on clean intermittent

catheterization (CIC) for decompression of the hydrocolpos and genitourinary system.

PSARP and cystovaginoscopy was performed at age of 9 months. She had a common channel of

2.5 cm, urethra of 1.5 cm, high rectum opening at the posterior aspect of the vagina and a bicornu-

ate uterus. The child was put in prone position for PSARP. The muscle complex was identified with

muscle stimulator and posterior sagittal incision all the way to the cloacal channel. The rectum was

then separated from the vagina and placed in the middle of the muscle complex. The pubo-urethral

ligaments were divided and TUM performed. The perineal body was reconstructed and the vagina

and urethra brought down as separate orifices.

RESULTS

The child was kept on antibiotic prophylaxis and oxybutynin for 2 weeks and was discharged home

at third post-operative day. The Foley catheter was removed 1 week after PSARP. She was voiding

well and had no infection. She was kept on anal dilatations until colostomy closure 3 months after

the procedure.

CONCLUSIONS

Repair of persistent cloaca using a posterior sagittal approach and total urogenital mobilization is

suitable for cases of good urethral length (more than 1.5 cm). In cases of shorter urethra, the vagina

should be separated and mobilized to the perineum as a pull through procedure.

VD-27 (VS without presentation)

ACCESS TO RETROPERITONEUM UNDER VISION USING

OPTIC TROCAR - TECHNIQUE

Pankaj Kumar MISHRA

and Abraham CHERIAN

1) Evelina London Children's Hospital, Paediatric Urology, London, UNITED KINGDOM - 2) Great Ormond Street

Hospital for Children, Paediatric Urology, London, UNITED KINGDOM

PURPOSE

Access into the retroperitoneum routinely has been by open cut down or the blind percutaneous

balloon technique with obvious disadvantages which has led to the development of this optical

access technique.