The Assessment of Lower Urinary Tract Function in Children with Anorectal Malformations before and after PSARP

Background: Lower urinary tract dysfunction (LUTD) with anorectal malformations (ARM) is usually associated with sacral and spinal abnormalities and less commonly due to iatrogenic pelvic nerve damage during surgery. Posterior sagittal anorectoplasty (PSARP) is believed to have a minimal deleterious effect on lower urinary tract function. Aim: The aim of this study was to assess the effects of PSARP on lower urinary tract function by means of urodynamic studies (UDS) performed before and after the definitive surgery in patients with ARM. Materials and Methods: The study was conducted between January 2003 and July 2005, in 17 cases of ARM (high/supralevator, n = 13 and low/infralevator, n = 4). All patients were subjected to preoperative UDS and then again 6 weeks after the PSARP. The parameters observed were maximum cystometric capacity (MCC), leak point pressure or end filling pressure (LPP/EFP), uninhibited detrusor contractions (UDCs) and compliance. Results: Associated vertebral anomalies were present in 38.5% (5 of 13) in high ARM compared with 25% in low ARM. The incidence of preoperative lower urinary tract dysfunction in various forms was found to be 70.5% (12 of 17 patients) and postoperatively the incidence was found to be 76.4% (13 of 17 patients). The pre- and postoperative mean MCC, volume at P-det < 20 cm, volume at Pdet < 30 cm and LPP were compared and found to be statistically not significant (p = 0.578, p = 0.551, p = 0.875 and p = 0.863, respectively). UDCs were present in 29.4% patients (5 of 17) preoperatively and 35.3% (6 of 17) patients postoperatively; however, only 16.6% (2 of 12) developed fresh UDCs. The incidence of LUTD did not differ if the patient had undergone PSARP or required abdominal dissection with PSARP. All 6 patients with vertebral or sacral anomaly had LUTD. Conclusion: There seems to be a high incidence of LUTD in ARM even in the absence of clinical and radiological evidence of lower urinary tract abnormalities. In addition, it was noted that there are changes, although statistically insignificant, in the neurovesical function of these patients following PSARP.