Bladder dysfunction in children with anorectal malformations: identification of risk factors and development of a predictive scoring tool.

Purpose: To evaluate lower urinary tract symptoms (LUTS) in toilet-trained children with anorectal malformations (ARM), identify risk factors for neurogenic bladder dysfunction (NBD) and develop a scoring system to predict poor urological outcomes.

Methods: This retrospective study reviewed records and conducted interviews for lower urinary tract symptoms (LUTS) and bladder management strategies in ARM patients treated at our center between April 2014 and March 2019. Logistic regression analysis identified risk factors, while a scoring system was developed using the Number Needed to Treat (NNT) metrics.

Results: Out of 166 patients, 32.5% (n = 54) exhibited LUTS. High ARM significantly increased the risk of NBD (RR: 2.43; p < 0.0001). Additional risk factors included vertebral anomalies (RR: 1.66; p = 0.0486), prior bladder surgeries (RR: 2.68; p < 0.0001), and abdomino-perineal reconstruction (RR: 2.88; p < 0.0001). The developed scoring system, with a threshold score of ≥ 12, demonstrated a sensitivity of 70.4% and specificity of 76.8% for predicting NBD.

Conclusions: This study highlights the significant prevalence of NBD in ARM patients and identifies critical risk factors. The scoring system offers a practical tool for early risk stratification, aiding in timely interventions. Further prospective studies are needed to validate the scoring system and refine management strategies.