GENITAL MALFORMATIONS AND COEXISTENT URINARY-TRACT OR SPINAL ANOMALIES IN PATIENTS WITH IMPERFORATE ANUS

Purpose: Urinary tract malformations have been described in up to 50% of patients with imperforate anus but genital anomalies have been less well analyzed in the same patient population. We sought to evaluate t he frequency of coexisting genital, urinary and spinal malformations i n a population with imperforate anus. Materials and Methods: We review ed 128 cases of imperforate anus, focusing on genital malformations an d their relationship to anomalies of the urinary tract and spine. The series included 69 boys and 59 girls with low (59), intermediate (22) and high (47) imperforate anus. Results: Boys were much more likely to have a genital or upper urinary tract problem than girls (26 or 50 ve rsus 5 or 30%, respectively). The risk for both sets of problems incre ased with the level of the anorectal lesion. The incidence of genital malformations increased from 14 to 26% in the presence of a renal lesi on and from 10 to 23% with an associated spinal problem. Conversely, t he incidence of urinary and spinal anomalies increased in patients wit h genital malformations. Conclusions: The genitalia of children with i mperforate anus should be carefully examined. Patients with anorectal malformations should also be evaluated for urinary tract and spinal pr oblems. The yield of such studies increases in patients with recognize d genital malformations.