Cloaca Reconstruction - Posterior Sagittal Anorectal Vaginal Urethral Plasty (PSARVUP)
What is posterior sagittal anorectal vaginal urethral plasty (PSARVUP)?
At approximately 5 months old, pediatric experts, including colorectal surgery, gynecology, urology and radiology, carefully examine the child’s anatomy to determine if the child needs a cloaca reconstruction procedure called a posterior sagittal anorectal vaginal urethral plasty (PSARVUP). Another type of cloacal surgery that accomplishes the same outcome is called a total urogenital mobilization (TUM). Your child’s surgeon will discuss the type of operative repair that is best for your child’s anatomy and outcomes.
This surgical procedure separates the three joined openings into three separate ones.
What is the goal of PSARVUP or TUM?
The goal of the PSARVUP procedure is to create three separate structures, a urethra, a vagina and an anus, so the child can safely pee and poop.
How is the PSARVUP or TUM procedure performed?
During a PSARVUP or TUM procedure, the three joined openings created by the cloacal defect are separated into three distinct openings. The result is a more normal anatomy so the child has a urethra, a vagina and an anus. Because the child typically has had a colostomy at birth, a couple of months later, the colostomy is closed, allowing the child to poop out of their bottom. Depending on your child’s anatomy, laparoscopy (minimally invasive surgery) can be utilized to decrease the number of large incisions.
Our team then follows the child with periodic anatomy checks to be sure the reconstruction heals properly and that the child’s development is on track. Some children with cloaca struggle with potty training, and some need additional reconstructive surgeries later.
What are the benefits of the PSARVUP or TUM procedure?
The PSARVUP procedure helps create a more normal anatomy so the child can pee and poop safely. Long term, this procedure also makes normal female sexual and reproductive functions possible.
Follow-up with a team that understands cloaca is very important. These complex surgeries are best done with the help of a multidisciplinary team such as the one available at the Comprehensive Colorectal Center.