title: Bowel function and lower urinary tract symptoms in males with low anorectal malformations: an update of controlled, long-term outcomes.
abstract: OBJECTIVE
  This study aimed to define the controlled outcomes into adulthood for bowel function and lower urinary tract symptoms (LUTS) for males treated for low ARMs with individualized, minimally invasive approaches that preserve the native continence mechanisms as far as possible.
  
  
  METHODS
  This is a single-institution, cross-sectional study. All males treated for low ARMs with cutback anoplasty, incision of anocutaneous membrane or dilatations based on the exact type of each malformation between 1983 and 2006 were invited to answer a detailed questionnaire on bowel function and LUTS. Each patient was matched to three controls representing the normal population. Ethical approval was obtained.
  
  
  RESULTS
  Amongst 46 respondents (67%; median age 12.3 (5-29) years), overall fecal control was comparable to controls (p = NS). All patients had voluntary bowel movements; 98% of patients and 97% of controls were socially continent (p = NS); 67% of patients and 64% of controls were totally continent (p = NS). Constipation amongst patients (33 vs 3% in controls; p < 0.0001) declined significantly with age. Outcomes by bowel function score were good in 85%, satisfactory in 15% and poor in 0%. Prevalence of LUTS and age at completion of toilet training were comparable to controls (p = NS).
  
  
  CONCLUSIONS
  Our results support the adequacy and appropriateness of treating males with low ARMs with individualized, minimally invasive perineal procedures. Long-term functional outcomes comparable to controls are achieved in the majority, provided that constipation is effectively addressed.
authors.affiliation: Department of Pediatric Surgery Hospital for Children and Adolescents, University of Helsinki, PL 281, 00029, HUS, Helsinki, Finland, kristiina.kyrklund@hus.fi.
authors.forename: Kristiina
authors.initials: K
authors.lastname: Kyrklund
authors.forename: Mikko P
authors.initials: MP
authors.lastname: Pakarinen
authors.forename: Seppo
authors.initials: S
authors.lastname: Taskinen
authors.forename: Risto J
authors.initials: RJ
authors.lastname: Rintala
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000150:complications / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005242:Fecal Incontinence / Q000503:physiopathology; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D012086:Reoperation; D012919:Social Behavior; D013997:Time Factors; D014039:Toilet Training; D016896:Treatment Outcome