Complications and Long-term Outcomes of Patients With Cloacal Malformation After Bowel Neovagina Creation

Abstract

Introduction

Up to 60 % of patients with a cloacal malformation have a Mullerian anomaly. In cases where the vagina is absent or cannot reach the perineum, an intestinal neovagina is often created. The complications and outcomes of this are not well described. We aimed to describe the gynecologic outcomes of patients who underwent neovagina creation followed at our institution.

Methods

A single institution retrospective review of patients ≥8 years old with cloacal malformation who underwent intestinal neovagina creation was performed. Demographics, surgical history, short-term complications, and long-term gynecologic outcomes were assessed.

Results

Forty patients were included. The median age at neovagina creation was 3.95 years (IQR 1.40, 7.61). Twelve patients (30 %) had uterine agenesis. Neovagina was colonic in 27 (67.5 %) and small bowel in 12 (30 %). Median age at most recent follow up was 9.7 years (IQR 7.6, 14.1).

There was no difference in 30-day complications, incidence of vaginal prolapse, introital stenosis, or graft stenosis between those undergoing small bowel vs colonic neovagina. Two patients had documented menstrual obstruction, and 11 patients reported bothersome vaginal discharge. Of those with neovagina prolapse, one small bowel (8.3 %) and two colonic grafts (7.4 %) required prolapse repair. One small bowel (8.3 %) and 7 colonic (26 %) patients underwent introitoplasty for stenosis. Of the 3 patients having penetrative sex, 2 reported dyspareunia. No patients have become pregnant.

Conclusion

Bowel neovaginas remain a suitable choice for patients with cloacal malformations in whom the vagina is absent or cannot reach the perineum.

Level of Evidence

IV.