UROLOGIC PROBLEMS IN ANORECTAL-MALFORMATIONS .1. URODYNAMIC FINDINGS AND SIGNIFICANCE OF SACRAL ANOMALIES

A series of 90 children with anorectal malformations received a total of 163 urodynamic studies. The mean number of studies per patient was 1.8 (range, 1 to 7), and the mean age at the time of initial evaluatio n was 17 months (range, 1 to 128). Sacral anomalies were found in 38 c hildren (42%); 30 of them had partial sacral agenesis and eight had sa cral dysplasia without bony defect. Normal lower urinary tract functio n was found in 98% of the children who had a normal sacrum, in all chi ldren who had sacral dysplasia, and in a small number of those who had partial sacral agenesis that affected smaller parts of the S-4 and S- 5 pedicles. Severe lower urinary tract dysfunction was observed in 22 patients (24%), all but one of whom had partial sacral agenesis. There was no correlation between the type of sacral agenesis and a specific urodynamic pattern. It is concluded that virtually all children with an anorectal malformation and associated sacral agenesis have neurogen ic bladder-sphincter dysfunction and therefore should receive early ur odynamic assessment and appropriate urologic treatment. Copyright (C) 1996 by W.B. Saunders Company