(125) Tubal Disease in Patients with Cloaca and Cloacal Exstrophy

Background: Females with complex anorectal malformations are at increased risk for impaired fertility. The cause of this impaired fertility is suspected to be multifactorial due to adhesive disease and surgical sequalae, Mullerian anomalies, and psychosocial factors. In a recent survey of female patients with anorectal malformations, 25% reported fertility problems, of which 37.5% reported blocked or damaged fallopian tubes. Little is known, however, about the implications of tubal disease in this population aside from the associated infertility risk. This study aims to identify the prevalence and management strategies of tubal disease in patients with cloacal anomalies at a single center.

Methods: A retrospective chart review was performed of female patients ages 10 to 40 years, with the diagnosis of cloacal anomaly, who presented to Children’s Hospital Colorado between 04/01/2014 and 04/01/2024. Descriptive statistics were reported as means and ranges for continuous variables and as frequency and percent for categorical variables. Tests of association included Welch’s independent two sample T-test for continuous variables as well as Chi square and Fisher’s exact tests for categorical variables.

Results: A total of seventy-four patients met inclusion criteria. The most common diagnosis was cloaca (73%) followed by cloacal exstrophy (24.3%). The average age of patients was 23.3 years. One third of patients required vaginal replacement, with colonic vaginoplasty being the most common in 9 patients (12.1%). Pelvic imaging was performed in 82.4% of patients, with tubal disease (hydrosalpinx, hematosalpinx, pyosalpinx, or pelvic inclusion cysts) identified in 31.1% of patients. Patients with a vaginal replacement or bladder augmentation were more likely to have tubal disease (p < 0.001 and p=0.015). Over half of patients (69.6%) had abdominal or pelvic pain of which 75% had a history of outflow obstruction and 50% a history of pelvic infection. Management of tubal disease varied and included no intervention (22.7%), surveillance ultrasound (22.7%), surgery (40.1%), and other treatments (13.6%) including antibiotics and drainage. Infertility counseling was performed and documented in 39.1% of visits.

Conclusions: Tubal disease was identified in nearly one third of patients with cloacal anomalies and over half of patients presented with pain. Patients with cloacal anomalies should be aware and counseled about the high risk of tubal disease and potential associated effects including impaired fertility and possible contribution to pelvic pain. Future studies are needed to identify patients most at risk for tubal disease , optimal management strategies for these patients, and long term outcomes.