Reoperative Anorectal Procedures in Patients with Anorectal Malformations - Is Bladder Function Affected?

Area of Science:

• Pediatric Surgery
• Urology
• Developmental Biology

Background:

• Anorectal malformations (ARM) are frequently associated with neurogenic bladder dysfunction.
• Traditional posterior sagittal anorectoplasty (PSARP) is presumed to minimally affect bladder dynamics.
• The impact of reoperative PSARP (rPSARP) on bladder function remains largely uncharacterized.

Purpose of the Study:

• To investigate the prevalence and nature of bladder dysfunction following rPSARP in patients with ARM.
• To evaluate changes in bladder management before and after rPSARP.

Main Methods:

• Retrospective review of ARM patients who underwent rPSARP between 2008 and 2015.
• Inclusion of patients with urology follow-up; data collection on ARM level, spinal anomalies, and reoperation indications.
• Assessment of urodynamic variables and bladder management strategies (voiding, CIC, diversion).

Main Results:

• Eighty-five patients met inclusion criteria with a median follow-up of 23.9 months.
• 18.8% of patients experienced a negative change in bladder management post-rPSARP, requiring intermittent catheterization or diversion.
• Bladder management changes were significant for mislocation and stricture indications, but not for rectal prolapse.

Conclusions:

• Reoperative PSARP is associated with a significant rate of negative changes in bladder management.
• Patients undergoing rPSARP require vigilant urological surveillance for potential bladder dysfunction.
• The findings highlight the need for careful consideration of bladder impact in the context of rPSARP.