Prevalence and Spectrum of Genitourinary Anomalies in Children with Anorectal Malformations

Adnan El-Ghazaly, Pediatric Surgery Department Mansoura University Children’s Hospital Mansoura University, Mansoura, EgyptFollow
Tamer A. Wafa, Pediatric Surgery Department Mansoura University Children’s Hospital Mansoura University, Mansoura, Egypt
Ahmed M. Negm, General Surgery Department Faculty of Medicine - Mansoura University
Adham W. El-Saied, Pediatric Surgery Department Mansoura University Children’s Hospital Mansoura University, Mansoura, Egypt

Corresponding Author

Adnan El-Ghazaly

Subject Area

Pediatric Surgery

Article Type

Original Study

Abstract

Background: Anorectal malformations (ARMs) encompass a broad range of congenital defects and are frequently associated with genitourinary (GU) anomalies, which may contribute to long-term morbidity if undetected. This study aimed to determine the prevalence and spectrum of GU anomalies in children with ARMs, describe the urological and genital findings, and assess associations with sex and ARM type.

Patients and Methods: A prospective survey enrolled children diagnosed with ARMs at a tertiary pediatric surgery center. All patients underwent standardized clinical assessment, including focused genital examination and structured imaging. Abdominal ultrasonography (US) served as baseline screening for urinary tract anomalies. Voiding cystourethrogram (VCUG) and diuretic renography were performed selectively for hydronephrosis evaluation or to rule out obstruction/reflux. ARMs were classified according to the Krickenbeck system. Associations between categorical variables were analyzed using chi-square or Fisher exact tests, with p < 0.05 considered significant.

Results: Among 162 children, 63 (38.9%) had GU anomalies: isolated urological in 30 (18.5%), isolated genital in 20 (12.3%), and mixed in 13 (8.0%). Urological anomalies occurred in 43 patients (26.5%), most commonly hydronephrosis (13.0%) and renal agenesis (6.2%). Hydronephrosis was mostly transient (38.1%), followed by ureteropelvic junction obstruction (19.0%) and vesicoureteral reflux. Genital anomalies were identified in 33 patients (20.4%). In males, undescended testes and hypospadias were most common; in females, septate vagina, Müllerian anomalies, and hydrocolpos predominated. GU anomalies were not associated with sex (p = 0.886). Among females, ARM type correlated with GU anomalies: short-channel cloaca had higher, and rectoperineal fistula had lower frequency (p = 0.001 and 0.003, respectively).

Conclusion: Over one-third of children with ARMs have GU anomalies, emphasizing the need for systematic screening and structured follow-up to prevent avoidable renal and reproductive complications.

Recommended Citation

El-Ghazaly, Adnan; Wafa, Tamer A.; Negm, Ahmed M.; and El-Saied, Adham W. (2026) "Prevalence and Spectrum of Genitourinary Anomalies in Children with Anorectal Malformations," Mansoura Medical Journal: Vol. 55 : Iss. 5 , Article 5.
Available at: https://doi.org/10.58775/2735-3990.1552