Assessment of Müllerian Patency in Patients With Cloacal Anomaly Using Saline Pertubation: A Retrospective Cohort Study

Purpose

36–41 % of females with cloaca experience menstrual obstruction, which can result in significant morbidity. No established evaluation exists to determine the patency of the pre-pubertal Müllerian system. Saline pertubation (SP)-- cannulating the fallopian tubes and injecting sterile saline-- can be performed during other indicated abdominal procedures. This study sought to assess the sensitivity and specificity of SP in predicting future patency of the Müllerian system among females with cloaca.

Methods

A retrospective review of patients with cloaca at a single institution from 2005 to 2023 was conducted (IRB#2023–0617). Menstrual patency was defined by the absence of obstruction by imaging or symptoms within 2 years of menarche, or between ages 9–13 years in patients with amenorrhea.

Results

255 patients with cloaca were reviewed. In those who met inclusion criteria by age or pubertal status, 79 Müllerian structures underwent SP in 52 patients. 75 structures were found to be patent, and four were found to be obstructed by SP. Four structures with patency on SP later developed obstruction. One structure without patency by SP had subsequent patency. SP was found to have a sensitivity of 95.9 % (95 % CI of 88.6–99.1 %) and specificity of 20 % (95 % CI of 0.5 %–71.6 %) for menstrual patency. One patient, patent on SP, developed a tuboovarian abscess 10 years after intervention and two patients patent on SP developed hydrosalpinx 8–10 years later. In 150 cloaca patients who did not undergo SP, three patients developed tuboovarian abscesses, and 22.8 % (29/127) of unobstructed patients developed hydrosalpinx.

Conclusions

SP among individuals with cloaca has a high sensitivity to identify those who are low risk for obstruction.

Study Type

Retrospective Cohort Study.

Level of Evidence

Level 3.