Aim: To investigate long-term results of treatment of patients with persistent cloaca in terms of proctological, urological and gynecological complications.

Material and methods: From 2006 to 2023, 32 children with diagnosis "persistent cloaca" had been operated. Patients were divided into 2 groups depending on the length of the common cloacal channel – 18 with a short cloacal channel less than 3 cm, and 14 with a long cloacal channel more than 3 cm. 5 different types of surgical interventions were performed depending on the length of common cloacal channel and the characteristics of the anatomical relationship of the urethra, vagina and rectum – posterior sagittal anorectovaginourethroplasty (PSARVUP), laparoscopically assisted rectal mobilization with perineal anorectoplasty and partial urogenital mobilization, abdominoperineal and posterior sagittal anorectovaginoplasty using colon and local tissue urethroplasty, vaginoplasty using ileum and local tissue urethroplasty, posterior sagittal anorectovaginourethroplasty with total urogenital mobilization.

Results: The long-term results of the operations were monitored for a period of 5 to 13 years after the operations. There were no immediate postoperative complications. The function of the gastrointestinal tract and intestinal control, the anatomical and functional state of the urinary system and the presence of gynecological disorders were assessed. In the group with a short cloacal channel, no fecal incontinence was detected in 11 (61%) children, episodic (no more than 2 times a week) in 6 (33%) children, daily incontinence in 1 (6%). In the group of children with a long cloacal channel, daily fecal incontinence was detected in all cases. 5 (36%) children daily, episodic in 9 (64%) children. Urological pathology was detected in 7 (39%) children with a short cloacal channel and in 8 (57%) children with a long cloacal channel, with the most severe complication being progressive renal failure. Urinary incontinence in most cases was functional, but three patients had sphincter insufficiency, requiring surgical correction in the future. Of the gynecological disorders, signs of hematometra were detected in 4 (13%) children. Retrovaginal fistula was detected in 2 (6%) children. 25 children had reached puberty by the time of assessment.

Conclusion: In the context of social adaptation, the prognosis for quality of life depends on the level of restoration of the function of fecal and urinary continence. Functional results of treatment were better in children from the group with a short cloacal channel, which is consistent with the literature data. The most severe consequences in terms of potential reduction in life expectancy are associated with concomitant pathology of the kidneys and urinary system. Gynecological disorders occur in puberty and may be associated with incomplete correction at the stage of the main stage of the operation.

Keywords: persistent cloaca; long-term results; complications; childhood

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