Persistent cloaca is a rare congenital defect in which the rectum, vagina, and the urinary tract form a common channel. Its surgical repair presents a serious challenge for pediatric surgeons with the goals being achievement of bowel control, urinary control, and sexual function. The first posterior sagittal repair of a cloacal malformation was performed in 1982. This involved a posterior sagittal operation, with or without a laparotomy, depending on the complexity of the defect. during the posterior sagittal approach, the rectum was separated from the urogenital sinus, the vagina was then separated from the urethra in an attempt to bring both structures (urethra and vagina) down to be placed in a normal location. What used to be the common channel was then reconstructed as a neourethra. During the last twelve years a maneuver called "total urogenital mobilization" has been utilized in which the rectum is spearated, but then the vagina and the urethra are mobilized together, as a unit, down to the perineum. This technique significantly shortens the operative time and eliminates the complications of urethral and vaginal strictures. The blood supply of these two structures, when kept together, is excellent, and better cosmetic results are achieved.