Cloacal Reconstruction with Total Urogenital Mobilization
This chapter describes the surgical procedure for cloacal reconstruction as performed by the following approaches: posterior sagittal anorectal vaginal urethral plasty (PSARVUP) and total urogenital mobilization (TUM). The text includes an introduction that outlines the indications, risks, alternatives, essential steps, needed equipment, and variations in technique for the procedure in question. This is followed by a template operative dictation, which provides the reader with an operative report, such as is found in a patient chart or electronic medical record. A description is provided of the following critical concepts for this procedure: definition of cloacal anatomy by endoscopy and cloacagram, posterior sagittal approach, mobilization of the rectum and separation of it from the posterior vagina, mobilization of the urogenital complex as a unit including incising of the suspensory ligaments of the urethra, urethroplasty and introitoplasty, rectoplasty, and closure of the posterior sagittal incision.