Annual Renal Surveillance With Ultrasound in All Anorectal Malformations May Not Be Necessary

Area of Science:

• Pediatric Surgery
• Urology
• Medical Imaging

Background:

• Children with anorectal malformations (ARM) face a higher risk of developing renal anomalies.
• Current protocols often involve annual renal ultrasounds (RUS) for all ARM patients, regardless of symptom severity.
• The necessity of this aggressive screening approach for all ARM cases remains uncertain.

Purpose of the Study:

• To evaluate the outcomes of children with various types of less severe ARM managed under a protocol of routine annual renal ultrasounds (RUS).
• To determine the clinical utility and yield of aggressive renal screening in this pediatric population.
• To assess the long-term impact of RUS screening on identifying and managing renal anomalies in children with mild ARM.

Main Methods:

• A retrospective review was conducted at a single pediatric colorectal center from 2014 to 2023.
• Included were children with less severe ARM (e.g., fistulas, stenosis, atresia) who underwent RUS within two years of primary repair.
• Data on demographics, clinical variables, and RUS findings (pre- and post-repair) were collected and analyzed using descriptive statistics.

Main Results:

• Out of 333 eligible children, 197 had a postoperative RUS within two years. The majority (70.1%) showed normal initial postoperative RUS results.
• Only four patients (2.0%) had RUS findings that became abnormal on later scans.
• A single asymptomatic child (0.5%) had a renal anomaly detected via RUS that required intervention, despite undergoing multiple screenings.

Conclusions:

• In children with mild ARM, routine annual RUS after primary repair yields a low incidence of intervention-requiring asymptomatic renal anomalies (0.5%).
• If the initial postoperative RUS is normal in patients with mild ARM, subsequent annual screening of asymptomatic individuals is unlikely to be necessary.
• This suggests a potential shift towards more selective renal screening protocols in this patient group, optimizing resource allocation and minimizing patient burden.