Enhancing Urethral Meatus Creation in Cloacal Malformations: A New Technique

We describe a novel urethromiatoplasty technique for cloacal repair patients, focusing on improving long-term functional and cosmetic outcomes in those with complex cloacal anomalies undergoing reconstructive surgery. In our previous technique, the urethra and vagina were brought up to the introitis and separately anastomosed. This resulted in poor definition of the vaginal vestibule and labia, often with skin separation between the urethra and vagina. In our new technique, the urethral meatus is positioned slightly recessed and. Posterior to the clitoris in a more orthotopic position, which rebuilds the vaginal vestibule as well. Key components of the technique include careful dissection and reconfiguration of the anterior and posterior urethra to form a patent orthotopic meatus that is slightly recessed, in addition to creating well-defined labia minora. In this patient who underwent cloacal repair with urogenital sinus separation and vaginal and anorectal pull-through, the common channel has become the urethra. It is noted by the catheter within the meatus. The first step is to recess the urethromeatus to a more orthotopic location by opening the urethromeatus and performing a urethromeattoplasty if necessary. The vagina has been pulled through. To recreate and build the vaginal vestibule, the vagina is slightly tubularized, and then re-approximated to the neourethral meatus at its inferior aspect. The perineal bodies are demarcated and the remainder of the vaginoplasty is performed. The perineal bodies are then re-approximated after marking out the location for the anal rectoplasty. The anal ectoplasty is then performed. A retrospective case series was conducted on 50 patients with cloacal anomalies who underwent primary cloacal repair between 2020 and 2024. Of these, 24 patients underwent urogenital sinus separation with vaginal and analectal pull-through, and 17 underwent total urogenital mobilization. The urethromiattoplasty technique was applied to 6 patients who underwent UG separation. And 5 patients who underwent TUM. On follow-up, all patients had satisfactory cosmetic results and successful neoatus creation with minimal scarring and a well-positioned urethral meatus. There were no instances of stenosis or fistula. 1 patient required clean intermittent catheterization. 3 patients underwent vesicostomy for bladder management, and 7 patients did not require assisted bladder emptying. This novel urethromattoplasty technique offers a promising option for cloacal anomaly repair, combining functional success with improved cosmetic outcomes.