[Lifelong Urological Follow-up in Patients with Anorectal Malformations: Continence, Urinary Tract Infections, Renal...

Anorectal malformations (ARM) present with a wide clinical spectrum in severity, with associated anomalies in up to 70% of cases. An increasing number of patients now reach adulthood, resulting in a shift in focus towards long-term function beyond the reconstructive period and securing transition of care. Urological morbidity is common and persists into adult life. Reported rates of urinary incontinence vary considerably depending on the severity of the malformation as well as associated sacral and spinal anomalies. Further sequelae include recurrent urinary tract infections, a retained remnant of the original fistula (ROOF), iatrogenic urogenital injury, chronic kidney disease, and impaired fertility.This narrative review proposes a risk-adapted follow-up scheme based on a structured history (voiding and bowel diaries), ultrasound, laboratory and microbiological assessment, as well as functional testing (uroflowmetry, urodynamics). These findings guide conservative treatment (urotherapy, bowel management, intermittent catheterization) and the decision for surgery. To date, no standardized follow-up recommendations exist for adult care. Risk-stratified interdisciplinary monitoring and initiation of transition at the onset of puberty are essential.