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Published on: January 7, 2019
Bowel and bladder outcomes in patients with anorectal malformations and sacral agenesis: a retrospective cohort study
J N Theeuwes1, C M C de Beaufort2,3,4, C J McDonald5
1Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.n.theeuwes@amsterdamumc.nl.
Insights
Patients with anorectal malformation and sacral agenesis often experience bowel and bladder dysfunction. Many require transanal irrigation (TAI) and clean intermittent catheterization (CIC) for management, highlighting the need for early counseling and follow-up.
Area of Science:
- Pediatric surgery
- Urology
- Developmental biology
Background:
- Anorectal malformation (ARM) and sacral agenesis (SA) frequently coexist.
- This combination increases the risk of long-term bowel and bladder dysfunction.
- Limited data exist to guide early management and counseling for these patients.
Purpose of the Study:
- To evaluate bowel and bladder outcomes in patients with concurrent ARM and SA.
- To assess the use and effectiveness of transanal irrigation (TAI) and clean intermittent catheterization (CIC).
Main Methods:
- Retrospective single-center cohort study.
- Included patients with ARM and SA born between 2000 and 2024.
- Assessed TAI/CIC use, fecal/urinary incontinence, and neurogenic bladder.
Main Results:
- 22 out of 33 patients (66.7%) aged ≥4 years used TAI, primarily for fecal incontinence.
- TAI use was associated with lower rates of fecal incontinence.
- 18 out of 41 patients (43.9%) initiated CIC, mainly for neurogenic bladder.
Conclusions:
- Concurrent ARM and SA patients are at high risk for chronic bowel/bladder issues.
- Many patients require structured bowel and bladder management strategies.
- Findings support proactive counseling and multidisciplinary care.
Purpose:
Patients with anorectal malformation (ARM) and associated sacral agenesis (SA) are at increased risk of long-term bowel and bladder dysfunction, but outcome data to guide early counselling and follow-up remain limited. We aimed to evaluate bowel and bladder outcomes in patients with concurrent ARM and SA, with a focus on transanal irrigation (TAI) and clean intermittent catheterization (CIC) use.
Methods:
In this retrospective single-center cohort study, all patients with ARM and SA born between January 2000 and January 2024 were included. SA was diagnosed radiologically and classified using Pang's classification. The primary outcome was TAI and/or CIC use. Secondary outcomes included fecal incontinence (≥ 4 years), urinary incontinence (≥ 5 years), and neurogenic bladder.
Results:
In total, 41 patients were included, with a median age at follow-up of 11.2 years. Of 33 patients ≥ 4 years, 22 (66.7%) used TAI during follow-up, primarily for fecal incontinence. Fecal incontinence was present in 26.3% of current TAI users versus 71.4% of non-users (p = .015). CIC was initiated in 18 of 41 patients (43.9%), mostly due to urodynamically confirmed neurogenic bladder. TAI and CIC use were associated with ARM complexity, but not with radiological SA severity.
Conclusion:
Patients with concurrent ARM and SA represent a high-risk group for long-term bowel and bladder dysfunction, and many require structured bowel and/or bladder management. These findings support anticipatory counselling and multidisciplinary follow-up.
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