Urological Abnormalities in Anorectal Malformation- A Single Centre Experience

Abstract

BACKGROUNDAssociation of anorectal malformations (ARM) and urological abnormalities have long since been described in literature. Studies have recommended that all children with ARM should undergo an USG of the urinary tract in the neonatal period. The role of MCU pre-and post-operatively has not been emphasized in literature. Our study was undertaken to study the urological abnormalities associated with ARM and the variations that have occurred postoperatively.METHODS 60 patients who had completed all stages of surgery for anorectal malformation and were on follow up, in the department of Paediatric Surgery, Medical College, Kottayam, were studied for associated anomalies, procedural complications and functional results with regard to urinary system. Post-operative assessment of these patients was done by interviewing the parents, urological assessment by clinical examination scoring and retrospectively studying the medical records available with the patient. Statistical analysis of data was done by chi-square test. RESULTSOf the 60 patients included in the study, majority were below 3 years of age (45%) while 15% were above 6 years of age. Associated anomalies were seen in 50% of cases. Commonest associated anomaly was genitourinary anomaly (31.7%). The surgical procedures done were PSARP in 26.7%, ASARP in 25%, SPM in 23.3%, anoplasty in 20% and abdomino-perineal pull through in 5% patients. Dribbling of urine was seen in 66.7% cases treated with abdomino perineal pull through, 64.3% treated with SPM and in 50% cases of PSARP. None had complete incontinence. Post-operative urological problems in the form of vesico-ureteric reflux /neurogenic bladder was seen in 7 patients (11.7%). Out of the 7, majority had undergone PSARP (6 cases). CONCLUSIONSPostoperative urinary symptoms in the form of dribbling of urine was seen more in SPM patients while urinary tract infections and VUR was seen more following PSARP than in SPM patients. This points to the need for a complete urological evaluation both before and after the definitive procedure.