A single center experience on clinical outcomes of vaginoplasty in cloacal anomaly: a retrospective cohort study.

PURPOSE: This study analyzed the demographics and clinical outcomes of vaginoplasty in patients with cloacal anomaly, focusing on the impact of surgical timing, method, and common channel length. Subgroup analyses evaluated the influence of timing across anatomical categories. METHODS: We retrospectively reviewed 28 patients who underwent vaginoplasty at Seoul National University Children's Hospital between 1989 and 2024. Data included associated anomalies, common channel length, timing and method of vaginoplasty, and outcomes related to menstruation, sexual activity, vaginal complications, bowel function, and urinary function. Patients were classified into three groups according to timing of vaginoplasty: Group A (simultaneous with anorectoplasty, n = 21), Group B (separate surgery before age 11, n = 3), and Group C (separate surgery after age 11, n = 4). Group A included both short and long common channel patients. Subgroup analysis was performed based on common channel length (≥ 3 cm vs. <3 cm). RESULTS: The median age at vaginoplasty was 12.5 months and pull-through was performed in 26 patients. The median age at anorectoplasty was 9 months in Group B and 13 months in Group C. Vaginal separation was performed at anorectoplasty in two of three Group B patients and one of four Group C patients, while the remaining patients underwent delayed vaginal separation. Menstruation occurred in 80% of post-pubertal patients, and 9.1% reported sexual intercourse. Group C showed higher rates of vaginal complications, longer operative times, and increased urinary tract infections. In subgroup analysis restricted to patients with long common channels, similar trends were observed. CONCLUSION: While functional outcomes were generally favorable, among patients with long common channels, delayed vaginoplasty after puberty was associated with higher rates of vaginal complications. These findings suggest that surgical timing may influence outcomes in this subgroup, although the retrospective design limits causal inference.