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Rethinking Routine Kidney Ultrasounds in Children With Mild Anorectal Malformations

Rethinking Routine Kidney Ultrasounds in Children With Mild Anorectal Malformations 1024 683 Lauren Dembeck
Molly Fuchs, MD

 

Annual scans rarely identify new kidney concerns in symptom-free children.

Children born with anorectal malformations (ARMs), a group of congenital conditions affecting the anus and rectum, are routinely screened for kidney abnormalities because of the association between ARM and urinary tract anomalies. The likelihood of urologic complications  increases with the complexity of the malformation. Yet, no clear guidelines define how often these children should undergo renal screening, resulting in wide variation in practice. In some of the most aggressive protocols, even children with milder forms of ARM, such as perineal or vestibular fistulas, receive annual renal ultrasounds regardless of symptoms. The true benefit of this approach, however, has remained uncertain, raising questions about whether aggressive, one-size-fits-all surveillance is necessary for every child.

“We started out being intentionally cautious,” says Molly Fuchs, MD, chief of the Department of Pediatric Urology at Nationwide Children’s Hospital. “When our center first opened, we wanted to make sure we didn’t miss any kidney issues, so we decided to get ultrasounds on every child each year. Over time, though, we noticed we were seeing many normal results and not adding much value for families.”

To determine whether routine annual imaging identifies clinically significant kidney abnormalities in asymptomatic children with mild ARM, Dr. Fuchs and colleagues conducted a retrospective study published in the Journal of Pediatric Surgery. The analysis included 333 children with mild ARM managed at Nationwide Children’s between 2014 and 2023, all of whom received at least one renal ultrasound within two years of their primary ARM repair.

Among 197 children with postoperative renal ultrasound data, 70% had normal initial scans, and nearly all of these remained normal on subsequent studies. Only four children (2%) developed new abnormalities, and just one child (0.5%) had an asymptomatic finding that required intervention. The team calculated that nearly 200 children would need to be screened each year to detect one actionable abnormality, suggesting that routine annual imaging may not be necessary in this low-risk group.

“It’s easy in urology to keep ordering tests ‘just to be safe,’ but we also have to be good stewards of health care resources,” Dr. Fuchs says. “Most of the children who needed follow-up imaging had symptoms. A good clinical evaluation often tells us more than a screening test alone.”

The study’s findings support a more tailored approach to postoperative renal surveillance, especially for children with mild ARM and an initially normal ultrasound. Dr. Fuchs emphasized that the goal is not to reduce follow-up, but to make it more individualized and clinically driven.

“We don’t want to think these children no longer need follow-up,” she explains. “What we have shown with this study is that if the initial ultrasound is normal, there may not be benefits to continuing to get yearly ultrasounds unless urinary symptoms develop. This stresses the importance of ongoing visits with urology providers to discuss urinary symptoms..”

Dr. Fuchs and her team plan to continue refining renal screening protocols to balance early detection with the burden of unnecessary testing.

“Our data give us confidence to scale back in the right situations,” she says. “Using evidence to guide our decision-making helps us provide the safest, most efficient care — and that’s ultimately better for both families and the health care system.”

 

Reference

Srinivas S, Booth K, Kasubick-Tillman S, Huskisson M, Griffin KL, Thomas E, Su M, Wood RJ, DaJusta DG, Fuchs ME. Annual Renal Surveillance With Ultrasound in All Anorectal Malformations May Not Be Necessary. Journal of Pediatric Surgery. 2025 Jul;60(7):162318. doi: 10.1016/j.jpedsurg.2025.162318. Epub 2025 Apr 7.

 

Image credit: Nationwide Children’s

About the author

Lauren Dembeck, PhD, is a freelance science and medical writer based in New York City. She completed her BS in biology and BA in foreign languages at West Virginia University. Dr. Dembeck studied the genetic basis of natural variation in complex traits for her doctorate in genetics at North Carolina State University. She then conducted postdoctoral research on the formation and regulation of neuronal circuits at the Okinawa Institute of Science and Technology in Japan.

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