title: Social quality of life for adult patients with anorectal malformations.
abstract: OBJECTIVE
  Pediatric surgeons who performed the initial surgery on anorectal malformations (ARM) lose contact with the patients as they become adults. In the present study, we examined 20- to 40-year-old adult patients with a history of surgery for ARM and analyzed them from the points of social quality of life.
  
  
  METHODS
  Twenty-nine patients with ARM, aged 20 to 40, were surveyed by questionnaire or personal interview. Thirteen with high-type and 9 with intermediate-type anomalies underwent abdominoperineal rectoplasty, and 7 with low-type anomalies underwent perineoplasty between 1965 and 1985. Responses were analyzed from the perspectives of bowel, urinary, and sexual functions and social activity.
  
  
  RESULTS
  One third of patients with high- or intermediate-type anomalies occasionally complained of fecal soiling. However, the other patients gained good bowel function and enjoyed occupational or student life without problems. Fecal soiling was the key factor disturbing occupational life, although the problem remained within a socially manageable level. All of the patients with ARM had normal urinary function. Three of the 18 male patients had sexual problems such as erectile or ejaculatory dysfunction because of associated genitourinary anomalies. Nine of the 11 female patients had regular menstruation and the other 2 had irregular menstrual periods. Five female patients were married and 4 of the 5 had children (1-5 children). Modes of delivery were normal vaginal delivery in 8 and cesarean section in 1. Only one of the 5 had a slight sacral anomaly. However, she had no apparent abnormality of bladder function and got through pregnancy and delivery without difficulty.
  
  
  CONCLUSIONS
  One third of adult patients with high- or intermediate-type anomalies after abdominoperineal rectoplasty had some problems in bowel function. Fecal soiling was the key factor that disturbed their occupational life. Most of the patients had normal urinary and sexual functions if they did not have associated genitourinary anomalies and enjoyed social activities.
authors.affiliation: Division of Surgery, Children's Research Hospital, Kyoto Prefectural University of Medicine, Kamigyo-Ku, Kyoto 602-8566, Japan. n-iwai@koto.kpu-m.ac.jp
authors.forename: Naomi
authors.initials: N
authors.lastname: Iwai
authors.forename: Eiichi
authors.initials: E
authors.lastname: Deguchi
authors.forename: Osamu
authors.initials: O
authors.lastname: Kimura
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kubota
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ono
authors.forename: Shinichi
authors.initials: S
authors.lastname: Shimadera
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D001003:Anal Canal / Q000002:abnormalities / Q000601:surgery*; D003672:Defecation / Q000502:physiology; D004065:Digestive System Abnormalities / Q000175:diagnosis / Q000601:surgery*; D004651:Employment; D005242:Fecal Incontinence / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007398:Interpersonal Relations; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology; D011788:Quality of Life; D012007:Rectum / Q000002:abnormalities / Q000601:surgery*; D012737:Sex Factors; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D014554:Urination / Q000502:physiology