Cystourethroscopy versus contrast studies in urogenital sinus and cloacal anomalies in children.

BACKGROUND Cloacal malformation is a spectrum of diseases affecting females, resulting in abnormal confluence of the urinary system, genital system, and/or gastrointestinal system. Proper reconstruction depends mainly on accurate preoperative illustration of the abnormal anatomy. Among the various modalities to delineate the urogenital sinus and the distances to confluence, lies the radiological contrast study, as well as the preoperative diagnostic cystourethroscopy. AIM OF THE STUDY The aim of this study was to compare the accuracy of the contrast study and diagnostic cystourethroscopy in the demonstration of the exact changes in anatomy resulting from urogenital sinus / cloacal abnormalities. METHODS Sixteen girls with median age 21 (11-27) months were studied. They included 4 girls with complete cloacal anomalies and 12 girls with persistent urogenital sinus secondary to congenital adrenal hyperplasia (CAH). Contrast studies and diagnostic cystourethroscopy were applied to all cases. Accuracy of both methods in delineating the abnormal anatomy was evaluated by comparison against intraoperative findings. Data are presented as median (range) or %. RESULTS Contrast studies accurately delineated the abnormal anatomy in 12 (75%), cases with 50% and 85% accuracy in cases of cloacal anomalies and persistent urogenital sinus, respectively. Cystourethroscopy was overall accurate in 15 cases (94%), with accuracy of 75% in cloacal anomalies and 100% in persistent urogenital sinus. CONCLUSION Although the presented series is small, it suggests that cystourethroscopy is superior to contrast studies in preoperative illustration of the abnormal anatomy in cases of cloacal malformations. These findings warrant confirmation in larger series. TYPE OF STUDY Diagnostic study. LEVEL OF EVIDENCE II.