CHRONIC UROGENITAL SINUS EXPANSION IN
RECONSTRUCTION OF HIGH PERSISTENT CLOACA
Long Li, Bai Ji-Wu, Wang Yian-Xia, Wang
Da-Yong, Tian Jun, Li Xiao-Song, Fang Tie, Zhang Jin-Zhe
Department of Surgery,
Beijing Children¡¯s Hospital, Beijing, China
Objective: Soft tissue expansion is a useful technique in
reconstruction when a shortage of tissue exists. This study presents the use of chronic balloon expansion
in urethral and vaginal reconstruction for high persistent cloaca.
Methods: Six patients with high persistent cloaca were
the subjects of this study.
The average age at time of surgery was 5.5 years (range, 6 months to
12 years). The length of the
common channel was ranged from 3.0 to 5.2 cm (mean 3.7¡À0.8cm) and the
diameter ranged from 0.4 to 1.0 cm (mean 0.6¡À0.2cm). Five of them suffered severe
urinary incontinence (grade IV) because of vesico-vaginal fistula. The common channel was expanded by
a balloon which was progressively inflated over three to four weeks at the
pressure of 30 to 50 mmHg until adequate tissue had been achieved. By posterior saggital approach, the
expanded tissue was longitudinally splitted into two segments; the anterior
segment was approximated to form a neourethra in continuity with the
reconstructed bladder neck, and the posterior segment was tubularized to
form a vagina. Urinary
continence was evaluated by urodynamic examination.
Results: The average duration of expansion was 25.0¡À2.9
days (21 to 28 days) and the average diameter of the urogenital sinus was
increased up to 2.6¡À0.2 cm (2.5 to 3.0 cm). All six patients underwent primary posterior saggital
urethro-vaginoplasty by using the expanded urogenital sinus. Histological examination
demonstrated the expanded tissue consisted of a dense fibrous wall lined by
a stratified squamous noncornified epithelium, which were characterized by
active cell mitoses and angiogenesis.
The patients have been followed up for 2.5 to 4 years now. All reconstructed urethra,
vagina and vulva were satisfactory in color, texture match and
sensation. Urinary continence
(grade I and II) was achieved in all patients without intermittent
catheterization. The only
complication encountered was distal urethral dehiscene in one case, which
was repaired by secondary urethroplasty six months after the operation.
Conclusion: Chronic balloon
expansion allows the creation of adequate tissue similar in appearance and
type to vagina and urethra, and provides a valuable surgical alternative
for managing high persistent cloaca.