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Urologic problems in anorectal malformations. Part 2: functional urologic sequelae

T M Boemers1, T P de Jong, J D van Gool

  • 1Department of Pediatric Urology, Wilhelmina Children's Hospital, University Hospital for Children and Youth, Utrecht, The Netherlands.

Journal of Pediatric Surgery
|May 1, 1996
PubMed
Summary
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Children with anorectal malformations often have neurogenic bladder-sphincter dysfunction, especially with sacral agenesis. Early detection and treatment, including clean intermittent catheterization (CIC), are crucial to prevent kidney damage.

Area of Science:

  • Pediatric Urology
  • Developmental Biology
  • Nephrology

Background:

  • Anorectal malformations (ARMs) are congenital anomalies that can impact lower urinary tract function.
  • Sacral agenesis is frequently associated with ARMs and neurogenic bladder-sphincter dysfunction.

Purpose of the Study:

  • To investigate the prevalence and characteristics of urologic problems in children with anorectal malformations.
  • To highlight the challenges in managing bladder-sphincter dysfunction and urinary incontinence in this population.

Main Methods:

  • Retrospective review of 90 children with anorectal malformations.
  • Urologic assessment including urodynamic testing where indicated.
  • Analysis of associated conditions, treatment outcomes, and parental compliance.

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Main Results:

  • 24% of patients exhibited neurogenic bladder-sphincter dysfunction, predominantly in those with sacral agenesis.
  • Vesicoureteral reflux (60%) and reflux nephropathy (32%) were common in patients with dysfunction.
  • Urinary incontinence affected 91% of patients with bladder-sphincter dysfunction.
  • Parental acceptance of clean intermittent catheterization (CIC) was challenging, particularly in older children.

Conclusions:

  • Early urodynamic testing is vital for identifying neurogenic bladder-sphincter dysfunction in neonates and infants with ARMs and sacral agenesis.
  • Prompt treatment, including CIC, is essential to prevent or mitigate secondary urologic morbidity, especially renal function loss.
  • Initiating CIC in the neonatal period or early infancy improves acceptance and compliance.