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Bladder dysfunction in children with anorectal malformations: identification of risk factors and development of a

Arka Banerjee1, Sukanya Vinchurkar2, Adwait S Bendre3

  • 1Wadia Hospital for Children, Mumbai, India.

Pediatric Surgery International
|August 22, 2025
PubMed

Insights

Children with anorectal malformations (ARM) often experience lower urinary tract symptoms (LUTS) and neurogenic bladder dysfunction (NBD). This study identified key risk factors and developed a scoring system to predict NBD in these patients.

Area of Science:

  • Pediatric Urology
  • Surgical Outcomes
  • Congenital Malformations

Background:

  • Anorectal malformations (ARM) are congenital conditions that can significantly impact lower urinary tract function.
  • Neurogenic bladder dysfunction (NBD) is a common complication in children with ARM, leading to potential long-term urological issues.
  • Early identification and management of NBD are crucial for optimizing outcomes in ARM patients.

Purpose of the Study:

  • To evaluate the prevalence of lower urinary tract symptoms (LUTS) in toilet-trained children with ARM.
  • To identify specific risk factors associated with the development of neurogenic bladder dysfunction (NBD) in this population.
  • To develop and validate a scoring system for predicting poor urological outcomes in children with ARM.

Main Methods:

  • Retrospective review of medical records and patient interviews for 166 ARM patients treated between April 2014 and March 2019.
  • Logistic regression analysis was employed to identify significant risk factors for NBD.
  • A predictive scoring system was developed using Number Needed to Treat (NNT) metrics.

Main Results:

  • 32.5% of ARM patients presented with LUTS.
  • High ARM (RR: 2.43), vertebral anomalies (RR: 1.66), prior bladder surgeries (RR: 2.68), and abdomino-perineal reconstruction (RR: 2.88) were significant risk factors for NBD.
  • The developed scoring system (threshold ≥12) showed 70.4% sensitivity and 76.8% specificity for predicting NBD.

Conclusions:

  • NBD is prevalent in ARM patients, with several identifiable risk factors.
  • The developed scoring system provides a practical tool for early risk stratification of NBD in ARM.
  • Further prospective studies are warranted to validate the scoring system and refine management strategies for improved urological outcomes.
Abstract

Keywords:
Anorectal malformationBladder dysfunctionNeurogenic bladderPredictive scoreUrologic outcome

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