A Case of Distal Vaginal Scarring following Cloacal Repair

Case Report

Austin J Urol. 2016; 3(2): 1044.

A Case of Distal Vaginal Scarring following Cloacal Repair

Jacobson NS¹*, Stock JA² and Fantl JA¹

¹Urogynecology, Mount Sinai School of Medicine, New York

²Pediatric Urology, Mount Sinai School of Medicine, New York

*Corresponding author: Nina S. Jacobson, Mount Sinai School of Medicine, 1176 5th Ave, NY 10029, New York

Received: June 21, 2016; Accepted: July 14, 2016; Published: July 18, 2016


Background: Newborns with severe cloacal malformations must undergo surgical reconstruction in infancy. Further surgical management during adulthood is often needed to restore specific functions.

Case: A 17 year old female presented with inability to engage in vaginal intercourse. She had undergone cloacal reconstruction in infancy. Pelvic exam revealed normal labia, a vaginal-urethral common opening <5mm and a fibrous scar at the distal vagina. Diagnostic evaluation included pelvic hydrosonovaginogram, Voiding Cystourethrogram (VCUG), MRI and Examination Under Anesthesia (EUA) with cystoscopy and vaginoscopy. Surgical repair consisted of a perineal flap vaginoplasty.

Summary and Conclusion: This report describes the importance of a thorough preoperative evaluation when managing gynecologic complications of a rare cloacal malformation. Vaginoplasty was performed without compromising bowel or bladder function.


Cloacal malformations are rare and complex birth anomalies. They represent the most severe form of anorectal malformations. Failure of the urogenital septum to separate the cloacal membrane results in the urethra, vagina and rectum opening into a single common channel. The world wide incidence is estimated at approximately one in 50,000 live births [1]. Majority of data available on patients with these anomalies focus on urinary and fecal continence as primary outcome measures. Very few publications specifically address gynecologic and obstetric outcomes [2].

Case Presentation

A 17 year-old female presented with a history of a cloacal malformation repaired as an infant. The specifics of her anatomy at birth as well as those of her reconstructive surgery were unknown. The operative report was not available. The patient provided letters of correspondence between her surgeon and consulting physicians. Through these letters it became known that she underwent urethroplasty, vaginoplasty, anoplasty and temporary colostomy with reversal. Reconstruction involved laparotomy and the use of small bowel for vaginal replacement.

Additionally, the patient had a diagnosis of vesicoureteral reflux and reduced function of her right kidney. Menarche occurred at age 15 and was followed by regular menstrual cycles with significant dysmenorrhea. She reported continence of bladder and bowel. The primary reason for consultation was the inability to engage in vaginal intercourse and an unsuccessful self-motivated trial of vaginal dilators.

Pelvic examination revealed normal labia and a vaginal-urethral common opening <5mm at the external urethral meatus site. However, the actual urethral meatus was not visible. A fibrous scar was seen between the anus and the common opening which allowed indentation upon digital pressure (Figure 1). Diagnostic imaging included apelvic hydrosonovaginogram, Voiding Cystourethrogram (VCUG) and MRI.