Urological Abnormalities Associated with Anorectal Malformation in Children Presented at Kanti Childrens’ Hospital

Abstract

Introduction: Anorectal malformations (ARM) are common congenital defects in children that are frequently associated with other congenital anomalies, particularly urological abnormalities. These urological anomalies, which increase in frequency and severity with more complex ARM types, can lead to significant complications such as upper urinary tract deterioration if not identified and managed early.

Methods: This prospective observational study at Kanti Children’s Hospital included 50 ARM patients from June 2024 to May 2025. All patients underwent baseline renal ultrasound; MCUG was done selectively for abnormal findings or symptoms. ARM was classified by Wingspread criteria and associated anomalies were documented. The study results were analyzed and compared with previously published data.

Results: Urological anomalies were detected in 44% of patients with anorectal malformations (ARM). The number of male patients with ARM was higher than females. Out of 50 patients, 23 had high-type ARM with 15 showing urological anomalies, 20 had intermediate-type with 7 anomalies, and none of the 7 low-type patients had urological anomalies. The most common urological abnormality identified was hydronephrosis (n = 13), followed by vesicoureteric reflux (VUR) (n = 5). Notably, four out of the five VUR cases were missed during the initial screening and were only diagnosed later during follow-up, often after the patient developed a urinary tract infection.

Conclusion: The high incidence of urogenital anomalies in patients with anorectal malformations highlights the need for thorough evaluation. Routine use of micturating cystourethrography (MCUG) is recommended, even when ultrasound findings are normal, to ensure early detection and timely management.