Identification of urological anomalies associated with anorectal malformation in southwestern Uganda: limitations and opportunities

Abstract

Introduction: Anorectal malformations (ARMs) may be associated with congenital anomalies affecting other body parts namely vertebral, anorectal, cardiac, tracheoesophageal, renal, and limb (VACTERL) with varying incidences of 7% - 60% [1-10]. Genitourinary defects might occur approximately in 50% of all patients with anorectal malformations [11] hence patients should be evaluated from birth to rule out these defects. Objective: To identify urological anomalies associated with anorectal malformation in southwestern Uganda Study design: This was a descriptive retrospective cohort study conducted at our regional referral hospital in Southwestern Uganda involving patients who have undergone surgical correction of ARMs between June 2021 and July 2023 Results: The overall prevalence of renal anomalies in our study patient population was 18.05%. Of those with ARM-associated renal anomalies, Specific anomalies included; renal agenesis (6.8%), hydronephrosis, (4.5%), duplex collecting system (3.8%), crossed fused kidney (1.5%), and ectopic kidney (0.75%). (Table) Author Manuscript Author Manuscript Author Manuscript Discussion: We found that the prevalence of ARM-associated renal anomalies was 18.05%, and the commonest anomaly was unilateral agenesis (6.8%) similar to other studies [12]. Previous data have shown renal anomalies are common anomalies in ARM[13]. While the exact values vary across studies, they all concluded that the rate of associated anomalies is extremely high in ARMs and warrants a thorough preoperative investigation once the ARMs are detected. This finding therefore underscores the importance of thorough evaluation and a multidisciplinary approach of care and follow-up system for ARM management including urologists even when the children are asymptomatic now. The main limitation of our study was missing information on patients' charts; we were not able to get the diagnosis since most patients didn’t have their discharge forms at the time of evaluation. Conclusion: ARM associated with renal anomalies may remain undiagnosed and asymptomatic. Those identified as asymptomatic need to be followed in a multidisciplinary fashion including pediatric urologists.