Aim of the Study: The goals of urinary reconstruction in urogenital sinus and cloacal repair include: (1) positioning of the bladder neck above the urogenital diaphragm to maximize future urinary continence and (2) creating a visible urethra that can be catheterized if needed. A recent algorithm in cloacal reconstruction proposed a urethral length of 1.5 cm as the key factor in deciding whether to perform a total urogenital mobilization (TUM) (for those urethras >1.5 cm) or urogenital separation (for those urethras <1.5 cm), similar to the algorithm that exists for urogenital sinus surgery, the hypothesis being that a 1.5 cm length urethra is needed for the patient to remain dry. We wondered if the normal female urethral length correlated with this empiric technical determinant.
Methods: We reviewed VCUGs of control patients between ages 6 and 36 months done for evaluation of UTI, pyelonephritis, or VUR and recorded the urethral length.
Results: 50 of 141 patients were excluded for inadequate image quality. There were no patients with urinary leakage between voids and therefore all were considered to have an intact urinary continence mechanism. The mean urethral length of the remaining 91 patient was:
Conclusion: A urethra of at least 1.5 cm was present in the vast majority of control normal patients. We believe therefore that for cloacal repair, surgeons can extrapolate that patients need a 1.5 cm urethra at the end of the reconstruction. If this is not achievable with a TUM, then a urogenital separation should be performed to maximize urethral length by providing the entire common channel for the urethra. Additional follow-up is needed to determine if this urethral length maintains dryness in the long term after cloacal repair.