Prenatal urinary ascites and persistent cloaca: Risk factors for poor drainage of urine or meconium

Purpose: The unique confluence of the urinary, genital and gastrointestinal tracts in girls with persistent cloaca potentially results in aberrant drainage-of urine and meconium that may be characteristic, allowing a prenatal diagnosis to be made. Materials and Methods: Three of our last 15 patients with cloacal anomalies presented with urinary ascites due to intraperitoneal reflux through the genital system. In 3 female patients a long, narrow cloaca was associated with a high confluence of the urethra, vagina and rectum. All 3 patients ultimately underwent creation of a cutaneous vesicostomy. Results: In all 3 cases cutaneous vesicostomy effectively diverted urine away from the cloaca before definitive repair. Conclusions: The urethra-like persistent cloaca may result in significant outflow resistance. When combined with high confluence, it may cause aberrant drainage of urine and/or meconium. When such problems are noted prenatally, they are likely to persist postnatally and require intervention.