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  1 , Tariq ABBAS  1 , Mansour ALI  1 and Joao Luiz PIPPI SALLE  2 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  1 and Abraham CHERIAN  2 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.