الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Anorectal malformation is one of the most common congenital anomalies encountered in pediatric surgical practices. Its global incidence is approximately 1 in every 4,000 to 5,000 live births, with a slight male preponderance. Approximately over 50% of children with ARM have associated abnormalities, whereby urological anomalies comprise more than half of associated abnormalities with incidence between 30% and 50%. The incidence of these anomalies increases with complexity of ARM or level of the deformity.
Screening of urological anomalies through a thorough genital examination and renal ultrasound imaging at birth or in the neonatal period is crucial to detect associated genitourinary anomalies for early management and avoidance of renal damage.
This study aimed to identify and classify the associated urological anomalies with anorectal malformation patients admitted to Pediatric Surgery Department at Alexandria University Children’s Hospital.
This retrospective observational study was conducted at the Alexandria University Children’s Hospital, mainly in pediatric surgery department. The study included prospective collection of data from all patients diagnosed with anorectal malformations between June 2021 and June 2023 who attended the Alexandria Pediatric Surgery Department. All patients diagnosed with anorectal malformation and underwent urological screening were included. All patient information based on our checklist was obtained from the patients’ files.
This study involved a total of 66 patients with ARM whereby 63.6% of them were male and 36.4% were female, and the median weight at presentation in the neonatal period was 2.80 (2.50-3.0) kg.
This study reported that among 66 patients with ARM, 19 and 47 patients had low and high anorectal anomalies, respectively. Low imperforate anus without fistula was the most common low anorectal anomaly (LARA), while high imperforate anus without fistula and rectovestibular fistula were the most frequent high anorectal anomalies (HARA). Also, high imperforate anus without fistula and rectovestibular fistula were the most common anorectal anomalies in males and females, respectively.
This study reported that screening of urological anomalies involved genital examination and renal ultrasound that were done to all patients during the neonatal period, and VCUG in selected cases. In 15 of 66 (22.7%) patients had abnormal genital examination findings, while 7 of 66 (10.6%) had abnormal renal US findings, who VCUG was performed.
The current study reported an overall incidence of urogenital anomalies in 22 of 66 (33.3%) ARM patients, whereby 12(54.5%) and 10(45.5%) were males and females respectively. Hypospadias was the most frequent genital anomaly followed by a bifid scrotum and an undescended testis. Absent kidneys and vesicoureteral reflux were the most common urological anomalies.
Moreover, this study reported that the incidence of urogenital anomalies was high in patients with high anorectal anomalies, with 20 of 47 patients with HARA had at least one urogenital anomaly.
In conclusion, screening of associated urological anomalies is vital to prevent renal damage and reduce morbidit