Multiple Choice Questions on Cloaca for Pediatric Surgery Trainees
MCQ 1: Long-term Goal of Surgical Correction in Cloacal Malformations
The primary long-term goal of surgical correction in patients with cloacal malformations is to achieve urinary and fecal continence while preserving sexual function and renal health.
Which of the following represents the most important long-term goal of surgical correction in cloacal malformations?
A. Cosmetic appearance of external genitalia B. Achievement of urinary and fecal continence with preservation of renal function C. Prevention of rectal prolapse D. Elimination of the need for intermittent catheterization E. Complete separation of all three channels without strictures
Answer: B
MCQ 2: Surgical Approach Based on Common Channel Length
A 3-month-old female presents with a cloacal malformation. Diagnostic studies reveal a common channel length of 4.5 cm. What is the most appropriate surgical approach?
A. Posterior sagittal approach alone B. Posterior sagittal approach with laparotomy C. Anterior sagittal approach alone D. Perineal approach only E. Laparoscopic repair without posterior sagittal incision
Answer: B
MCQ 3: Postoperative Complications
A 4-year-old girl who underwent cloacal repair as an infant now presents with urinary incontinence and recurrent UTIs. MRI shows tethered cord. What is the most likely explanation for her symptoms?
A. Inadequate bladder neck reconstruction B. Persistent urogenital sinus C. Neurogenic bladder due to tethered spinal cord D. Vesicoureteral reflux E. Urethral stricture
Answer: C
MCQ 4: Management of Hydrocolpos
A newborn female is diagnosed with cloacal malformation and significant hydrocolpos. What is the most appropriate initial management?
A. Immediate complete cloacal repair B. Colostomy only C. Drainage of hydrocolpos and colostomy D. Observation until definitive repair E. Vaginal replacement with bowel segment
Answer: C
MCQ 5: Long-term Functional Outcomes
Based on large clinical series of patients with cloacal malformations, what percentage of patients can be expected to achieve voluntary bowel movements?
A. 10-20% B. 30-40% C. 50-60% D. 70-80% E. 90-100%
Answer: C
MCQ 6: Reoperations After Failed Repair
A 5-year-old girl who had cloacal repair at another institution presents with persistent urogenital sinus. What was the most likely error during the initial repair?
A. Excessive mobilization of the rectum B. Failure to recognize the cloacal malformation (misdiagnosed as rectovaginal fistula) C. Inadequate bowel preparation D. Inappropriate suture material E. Excessive tension on the vaginal anastomosis
Answer: B
MCQ 7: Urological Management
A 7-year-old girl who underwent cloacal repair as an infant has recurrent UTIs and hydronephrosis. Urodynamic studies show a small, thick-walled bladder with detrusor overactivity. What is the most appropriate management?
A. Antibiotic prophylaxis only B. Clean intermittent catheterization and anticholinergics C. Immediate bladder augmentation D. Ureteral reimplantation E. Vesicostomy
Answer: B
MCQ 8: Prognostic Factors
Which of the following factors is the strongest predictor of long-term urinary continence in patients with cloacal malformations?
A. Age at definitive repair B. Length of the common channel C. Presence of sacral anomalies D. Type of colostomy created E. Surgeon's experience
Answer: B
MCQ 9: Associated Anomalies
A newborn with cloacal malformation undergoes initial evaluation. Which associated anomaly should be most urgently evaluated before surgical intervention?
A. Tethered spinal cord B. Congenital heart defects C. Limb anomalies D. Gastrointestinal duplications E. Renal agenesis
Answer: B
MCQ 10: Vaginal Reconstruction
A 2-year-old girl with cloacal malformation has a common channel of 5 cm and inadequate vaginal tissue for primary reconstruction. Which option provides the best functional outcome for vaginal replacement?
A. Colon segment B. Small bowel segment C. Rectal segment D. Skin graft E. Bladder mucosa flap
Answer: B
The long-term goal of surgical correction in cloacal malformations is to achieve urinary and fecal continence while preserving sexual function and protecting renal health 1. This complex congenital anomaly requires careful planning and meticulous surgical technique to achieve optimal functional outcomes 2, 1.
The length of the common channel is the most important factor in determining surgical approach and prognosis. Patients with common channels longer than 3 cm require a combined posterior sagittal approach with laparotomy and have more complex reconstructive needs 1, 3. These patients also have a higher incidence of urological complications and often require special maneuvers for vaginal reconstruction 1.
Proper management begins in the neonatal period with accurate diagnosis, drainage of hydrocolpos when present, and creation of an adequate diverting colostomy 2, 1. Failure to recognize the full extent of the malformation is a common pitfall that leads to incomplete repair and persistent urogenital sinus 3.
Long-term outcomes show that approximately 53% of patients achieve voluntary bowel movements, with the remainder requiring bowel management programs 1. The need for intermittent catheterization is significantly higher (70%) in patients with common channels longer than 3 cm compared to those with shorter common channels (20%) 2, 1.
Renal function must be monitored throughout life as up to 50% of patients may develop renal failure 4. Associated spinal anomalies can lead to neurogenic bladder dysfunction, further complicating management 5, 4.