Predicting Urinary Continence For a Child With Anorectal Malformation

Predicting Urinary Continence For a Child With Anorectal Malformation 150 150 Kevin Mayhood

Researchers suggest objective, measurable factors can be used to provide families with reasonable expectations

In a child born with an anorectal malformation (ARM), anatomical features including a low-complexity ARM, high sacral ratio and a normal spine each independently predicts the child has a higher chance of urinary continence, research at Nationwide Children’s Hospital shows.

“When you see an infant with ARM in the clinic, the family wants to know ‘What will my child look like when he gets older, what’s going to happen?’” says Molly Fuchs, MD, a pediatric urologist and surgeon in the Section of Urology at Nationwide Children’s and lead author of the study. “We haven’t had a lot of answers.”

“With this study, you can look at these three anatomic features and give the family an idea of whether or not you think the baby will potty train or void  normally when they get older, or need diapers or surgery,” says Dr. Fuchs, who is also a clinical assistant professor of urology at The Ohio State University College of Medicine. “That can be powerful information for families, just to have reasonable expectations.”

Dr. Fuchs presented the research findings at the Pediatric Urology Fall Congress in Scottsdale, Ariz. in September.

The investigators retrospectively reviewed records of 434 children with ARM from a prospectively collected database. The study included children older than 4, whose records included lateral sacral measurements and MRI spinal cord imaging.

These anatomic features make up the ARM index, which in an earlier multi-center study showed that ARM severity was predictive of fecal continence.

In this study, the researchers found that a simple ARM, a sacral ratio of greater than 0.7 and normal spinal cord each independently predict a child will have a 75% chance of urinary continence. A complex ARM, sacral ratio of less than 0.4 and myelomeningocele each independently predict about a 25% chance of continence.  If the anatomic features fall between the extremes, each independently predicts about a 50% chance of continence.

“The anatomic features are all things present in infancy; they are objective and measurable,” Dr. Fuchs says. “Now we can guide families in their expectations for how their child will be able to urinate based on their specific anatomic measurements. It’s not a perfect predictor but it can help to have some idea of their chance to potty train.”

Next, Dr. Fuchs and her colleagues will continue their analysis, studying whether one anatomical feature is a stronger predictor than the others. They are working toward developing a grading system that predicts continence using the combined influence of the three features.

Further, they plan to delve into whether these or other measurable features are predictive of kidney failure, renal insufficiency and other long-term urologic outcomes for children with ARM.



Fuchs ME, Halleran DR, Sebastião Y, Weaver L, Ahmad H, Ching CB, Levitt MA, Wood RJ, Dajusta DG. Anatomic factors predict urinary continence in patients with anorectal malformation. The Societies for Pediatric Urology Pediatric Urology Fall Congress. Sep 26-29; Scottsdale, Ariz.

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