Publication:

Neurovesical dysfunction in anorectal malformation

Background Anorectal malformations are congenital anomalies characterized by the absence of a normally formed anus. Obstructive uropathy, vesicoureteral reflux neurovesical dysfunction are the leading causes of mortality and morbidity in ARM. Early diagnosis and treatment of NVD prevents renal parenchymal damage.Surgical interventions for the correction of anorectal malformation may also lead to the development of NVD. The incidence of urologic and spinal anomalies associated with ARM and the relationship between the anorectal malformations, spinal abnormalities and voiding dysfunction was studied by means of MRI spine and urodynamic studies.

Methods A prospective, observational study was done over a period of 2 years. All patients with ARM underwent MRI of the spine, ultrasound of abdomen, micturating cystourethrogram and urodynamic study.

Results Forty two patients were included in this study. Out of the 42 patients 17 (40.5%) were female and 25 (59.5%) were male. The ages of the patients ranged from 4 months to 14 years with an average of 32.9 months. 5 patients (12%) had complaints pertaining to neurovesical dysfunction. MRI of the spine revealed abnormalities in 10 patients (23.8%). Urodynamic study was abnormal in 8 patients (19%). Therefore a total of 8 patients (19%) had neurovesical dysfunction in the present study. This included 3 female patients with cloaca and 5 male patients with high anorectal malformations.

Conclusions Neurovesical dysfunction is frequently seen in patients with anorectal malformations. NVD may be due to the spinal abnormalities or due to iatrogenic injuries to the bladder innervations during surgical reconstruction.