Repair of “bladder neck” cloaca using a trans-vesicle approach: A case report
Bibliographic record
Abstract
Cloaca with a common channel greater than 3 cm typically requires urogenital separation rather than total urogenital mobilization. The purpose of this report was to describe our experience managing a female infant with an usual form of cloaca where all structures inserted onto the bladder neck. A female infant with a single perineal opening underwent loop sigmoid colostomy shortly after birth. She voided spontaneously and had no hydrocolpos. She underwent exam under anesthesia, cystoscopy, and cloacogram under a single anesthetic at 5 months of age. This revealed five structures that inserted directly into the bladder: a central rectal fistula, two hemivaginas and hemiuteri bilaterally, and two ureters without hydronephrosis. The outflow tract was a long common channel measuring 5.2 cm. This patient was reviewed in a multidisciplinary setting and underwent repair at 10 months of age. We performed a midline laparotomy and opened the anterior wall of the bladder to visualize the structures that inserted posteriorly. Foley catheter and ureteric stents were placed. The rectal fistula and hemivaginas were mobilized off the bladder internally. Vaginal replacement was performed using a transverse portion of rectum. Additional colonic length was achieved by converting the loop colostomy to an end-loop. The abdomen was closed and posterior sagittal anorectoplasty was performed in a prone position. This infant underwent repair of a “bladder neck” cloaca using a transvesicular approach. She is now 35 months of age and thriving. She developed neurogenic bladder requiring clean intermittent catheterization and is working on fecal continence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".