Vesicoureteral reflux and anorectal malformations

Area of Science:

• Pediatric Urology
• Neonatal Surgery
• Medical Imaging

Background:

• Anorectal malformations (ARMs) are frequently linked with renal and urinary tract anomalies.
• Early detection of these urologic issues is crucial for preventing adverse long-term renal outcomes.
• Predictors for significant urologic abnormalities in various ARM phenotypes are not well-established.

Purpose of the Study:

• To assess the prevalence and grade distribution of vesicoureteric reflux (VUR) in neonates with ARMs.
• To investigate associations between VUR and other renal/urinary tract anomalies.
• To explore factors linked to high-grade VUR and complex ARM phenotypes.

Main Methods:

• Retrospective cross-sectional study of 64 neonates with ARMs (2018-2025).
• All patients underwent renal/urinary tract ultrasonography and voiding cystourethrography (VCUG).
• Analysis included demographic data, ARM complexity, urologic findings, UTI history, and associated anomalies; multivariable logistic regression was used.

Main Results:

• Renal and urinary tract anomalies were common: hydronephrosis (48.4%), any-grade VUR (39.1%), hydroureter (35.9%).
• High-grade VUR occurred in 21.9% of patients; UTI history was present in 18.8%.
• No demographic or clinical factors reliably predicted complex ARM phenotype or high-grade VUR (AUC = 0.60 for VUR prediction).

Conclusions:

• Vesicoureteric reflux (VUR) is a significant finding in neonates with anorectal malformations (ARMs).
• The absence of reliable clinical predictors for high-grade VUR or complex ARM phenotypes challenges selective screening.
• Comprehensive urologic evaluation is essential for all neonates with ARMs, irrespective of their specific anatomic subtype.