Associated genitourinary tract anomalies in anorectal malformations: a thirteen year review.

ABSTRACT

Congenital anomalies in the genitourinary tract are the leading associated anomalies in infants with anorectal malformations (ARM). Certain anomalies such as vesicoureteric reflux (VUR) may cause permanent renal damage. OBJECTIVE: To review associated genitourinary tract anomalies in-cases of anorectal malformations and evaluate the efficacy of ultrasonography in detecting VUR. MATERIAL AND METHOD: Retrospective review of 183 patients with ARM undergoing anoplasty between 1988-2001. RESULTS: Genital anomalies were found in 14 per cent (26 cases). Urologic anomalies were detected in 25.6 per cent (47 cases), with a higher incidence in supralevator anomalies. The most common upper tract anomaly was hydronephrosis, which resolved spontaneously in most of them. VUR was found in 16 cases (21 refluxing units) or 20 per cent of patients to whom voiding cystourethrogram (VCUG) was done. Sonography detected hydroureter and/or hydronephrosis in 3 of 21 refluxing units, despite 17 of them being grade three or more. Half of the cases with reflux had urinary tract infection at least once in the follow-up period despite normal initial urinalysis. Parenchymal scar was positive in four cases with VUR. CONCLUSION: Thorough evaluation of the urinary tract is necessary in infants with anorectal malformations. Ultrasound is an accurate tool in the examination of the upper tract, but not sensitive enough to detect lower tract anomalies, especially VUR.