ASSOCIATED UROLOGIC ANOMALIES IN LOW IMPERFORATE ANUS ARE CAPABLE OF CAUSING SIGNIFICANT MORBIDITY - A 15-YEAR EXPERIENCE

Objectives. To determine the incidence and morbidity caused by urologi c anomalies in patients with low imperforate anus. Methods. The case r ecords and imaging studies of 95 patients who underwent surgery for lo w imperforate anus over a 15-year period were retrospectively reviewed . Follow-up ranged from 2 to 18 years (mean 5.4). Results. Genitourina ry abnormalities were seen in 29 patients (31%), whereas 10 (11%) had lumbosacral abnormalities. A micturating cystourethrogram was performe d in 48 patients, 18 of whom were shown to have vesicoureteric reflux and 2 of whom required surgical correction. Three additional patients required bilateral ureteric reimplantation: 2 had megaureters whereas 1 had bilateral ectopic ureters, Four patients had evidence of chronic renal failure; these included 1 patient with reflux nephropathy, 2 wi th bilateral dysplastic kidneys, and 1 with neurogenic bladder. The pa tient with reflux nephropathy underwent renal transplantation at the a ge of 18 years. Two patients had proximal hypospadias and 4 had undesc ended testes. A neurogenic bladder was documented in 5 children, 4 of whom had lumbosacral abnormalities. One of these had a spinal lipoma a nd required excision of the lipoma and untethering of the spinal cord. Conclusions. We conclude that 30% of patients with low imperforate an us would have associated urologic anomalies, several of which are capa ble of causing significant morbidity. Thus, all patients with imperfor ate anus, whether high or low, need to be screened for associated urol ogic anomalies.