{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:20:59Z","timestamp":1792110059221,"version":"4.4.0"},"reference-count":6,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T00:00:00Z","timestamp":1675728000000},"content-version":"vor","delay-in-days":37,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["European J Pediatr Surg Rep."],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Introduction\u2003Cloacal malformations comprise a heterogeneous group of anomalies that are considered the most complex anorectal malformations (ARMs) in females. Precise evaluation to identify the unique anatomy prior to reconstruction with collaboration between colorectal surgeons, urologists, and gynecologists is vital. Here, we present a rare anatomical variation in a patient with a cloacal malformation which affected operative and postoperative management.<\/jats:p><jats:p>\n          Case description\u2003A 6-year-old female with cloaca who underwent colostomy, vaginostomy, and vesicostomy as a newborn presented for reconstruction. Her VACTERL workup was negative except for an atretic right kidney. Her ARM index included the cloaca, a normal spine, and sacrum with a lateral sacral ratio of 0.7, predicting good potential for bowel continence. Cystoscopy through the vesicostomy showed a small bladder with normal ureteral orifices, and a closed bladder neck, with no identifiable urethra. A cloacagram showed an atretic common channel, a single small vagina, and a rectum below the pubococcygeal line. The patient underwent a posterior sagittal anorectovaginourethroplasty, vaginal patch using rectum, rectoplasty, and perineal body reconstruction. The urethra was not amenable to reconstruction, so the vesicostomy was preserved and a future Mitrofanoff was planned.<\/jats:p><jats:p>\n          Conclusion\u2003Urethral atresia is a rare and challenging finding in cloaca patients, and a vesicostomy is needed to drain urine in the newborn period. Preoperative examination under anesthesia, cystoscopy, vaginoscopy, and cloacagram are crucial to identify the precise anatomy and to plan accordingly.<\/jats:p>","DOI":"10.1055\/s-0043-1761206","type":"journal-article","created":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T00:04:07Z","timestamp":1675814647000},"page":"e1-e4","source":"Crossref","is-referenced-by-count":2,"title":["Cloacal Malformation with Associated Urethral Atresia"],"prefix":"10.1055","volume":"11","author":[{"given":"Tamador","family":"Al-Shamaileh","sequence":"additional","affiliation":[{"name":"Department of General Surgery, King Hussein Cancer Center, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8085-8370","authenticated-orcid":false,"given":"Laura","family":"Tiusaba","sequence":"additional","affiliation":[{"name":"Division of Colorectal and Pelvic Reconstruction, Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9106-092X","authenticated-orcid":false,"given":"Shimon Eric","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Division of Colorectal and Pelvic Reconstruction, Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1331-9585","authenticated-orcid":false,"given":"Teresa Lynn","family":"Russell","sequence":"additional","affiliation":[{"name":"Division of Colorectal and Pelvic Reconstruction, Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizaveta","family":"Bokova","sequence":"additional","affiliation":[{"name":"Division of Colorectal and Pelvic Reconstruction, Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans G.","family":"Pohl","sequence":"additional","affiliation":[{"name":"Department of Urology, Children's National Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Briony K.","family":"Varda","sequence":"additional","affiliation":[{"name":"Department of Urology, Children's National Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Urology, Children's National Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Feng","sequence":"additional","affiliation":[{"name":"Division of Colorectal and Pelvic Reconstruction, Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Badillo","sequence":"additional","affiliation":[{"name":"Division of Colorectal and Pelvic Reconstruction, Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A.","family":"Levitt","sequence":"additional","affiliation":[{"name":"Division of Colorectal and Pelvic Reconstruction, Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,2,7]]},"reference":[{"issue":"17","key":"ref1","first-page":"30644","article-title":"Cloaca reconstruction: a new algorithm which considers the role of urethral length in determining surgical planning","volume":"S0022\u20133468","author":"R J Wood","year":"2017","journal-title":"J Pediatr Surg"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"2241","DOI":"10.1016\/S0022-5347(05)66174-5","article-title":"Urethral atresia: long-term outcome in 6 children who survived the neonatal period","volume":"165","author":"R Gonz\u00e1lez","year":"2001","journal-title":"J Urol"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1016\/S0022-3476(79)80210-3","article-title":"Urethral obstruction malformation complex: a cause of abdominal muscle deficiency and the \u201cprune belly\u201d","volume":"94","author":"R A Pagon","year":"1979","journal-title":"J Pediatr"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/j.1464-410X.1993.tb06470.x","article-title":"Urethral atresia and the prune belly syndrome. Report of 6 cases","volume":"72","author":"Y Reinberg","year":"1993","journal-title":"Br J Urol"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1053\/j.sempedsurg.2009.11.012","article-title":"Cloacal malformations: lessons learned from 490 cases","volume":"19","author":"M A Levitt","year":"2010","journal-title":"Semin Pediatr Surg"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1053\/j.sempedsurg.2015.11.009","article-title":"The surgical treatment of cloaca","volume":"25","author":"A Bischoff","year":"2016","journal-title":"Semin Pediatr Surg"}],"container-title":["European Journal of Pediatric Surgery Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1761206.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T18:03:15Z","timestamp":1690394595000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1761206"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":6,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2023,2,7]]},"published-print":{"date-parts":[[2023,1]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1761206","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2194-7619","2194-7627"],"issn-type":[{"value":"2194-7619","type":"print"},{"value":"2194-7627","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]}}}