Subclitoral Meatus | W. Hardy Hendren Pediatric Surgical and Urological Education Foundation

18-Month-Old Female Patient with Unusual Cloaca (Hendren Patient Case)

6½-year-old female patient was referred in 1976 for extensive secondary surgery of her cloacal malformation
Thirteen prior operations included:
- Colostomy at birth
- Bilateral loop ureterostomies
- Attempted vaginal pullthrough
- Opening of the urogenital sinus
- Suprapubic cystostomy
- Closure of the bladder neck

15-year-old female patient referred in 1981 for cloacal repair
Work up at birth at two University Centers concluded patient had female pseudohermaphroditism without endocrine cause
Prior surgery was cutback of UGS and laparotomy to view (normal) pelvic organs.

17-year-old female referred in 1979 with total urinary and fecal incontinence despite multiple misdirected procedures for her basic cloacal malformation
Severe hypertension secondary to renal scarring demanded immediate medical treatment

Newborn female patient
Esophageal atresia repaired as neonate
Had cloaca
Loop sigmoid colostomy was done
Referred at age 5½ years for cloacal repair
Chronic spillover of stool from loop colostomy, filling vagina and bladder with reflux, severe renal scaring

4-year-old girl sent from abroad in 1986
Right colostomy at birth
At age 4 months, posterior sagittal operation was attempted, but abandoned after the UGS was inadvertently transected
An S.P. tube was placed
8 months later, colostomy was closed and a stricture of the neourethra was opened endoscopically
Patient was sullen, unhappy, and uncommunicative when first seen

Neonate treated in 1975--early in experience with cloacal reconstruction
Sigmoid colostomy was done, but transverse colostomy now preferred
Demonstrated repair in lithotomy position to be possible, although today a posterior sagittal approach might be used
Hendren's first cloacal repair in 1962 had the vagina exteriorized with a perineal flap, and the rectum was repaired by a posterior sagittal approach and pullthrough