title: Bowel function and lower urinary tract symptoms in females with anterior anus treated conservatively: Controlled outcomes into adulthood.
abstract: OBJECTIVE
  Anterior anus (AA) is a low type of anorectal malformation that is seen exclusively in females, characterized by an essentially normal appearing anus in an abnormally anterior position. In AA, the anal canal is located mostly within the voluntary sphincter complex, differentiating it from a perineal fistula in females, and allowing for a nonoperative approach to management. This study aimed to characterize the controlled, long-term bowel functional outcomes and lower urinary tract symptoms (LUTS) in females with conservatively treated anterior anus.
  
  
  METHODS
  A single-institution, cross-sectional study. All females treated conservatively for AA between 1983 and 2006 were invited to answer a postal questionnaire on bowel function and lower urinary tract symptoms. Each patient was matched by age and gender to 3 controls that had answered the same questionnaire. Ethical approval was obtained.
  
  
  RESULTS
  Among 45 respondents (67%; median age 10.2 (4-20) years), fecal continence was comparable to controls overall (p=NS). Constipation affected a significantly higher proportion patients (36%) than controls (13%; p=0.002) and tended to decline with age. Outcomes by bowel function score were good/normal in 93%, satisfactory in 7% and poor in none. Lower urinary tract symptoms and age at toilet training were comparable to controls (p=NS).
  
  
  CONCLUSIONS
  Up to adulthood, long-term bowel functional outcomes comparable to matched peers can be achieved in nearly all of females with AA with conservative management alone, provided that effective control of constipation is achieved. The prevalence of LUTS is comparable to controls, and toilet training can be expected to occur at the normal age.
authors.affiliation: Department of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland. Electronic address: kristiina.kyrklund@hus.fi.
authors.forename: Kristiina
authors.initials: K
authors.lastname: Kyrklund
authors.affiliation: Department of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
authors.forename: Mikko P
authors.initials: MP
authors.lastname: Pakarinen
authors.affiliation: Department of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Taskinen
authors.affiliation: Department of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
authors.forename: Risto J
authors.initials: RJ
authors.lastname: Rintala
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000002:abnormalities*; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000175:diagnosis; D016022:Case-Control Studies; D003248:Constipation / Q000209:etiology; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005242:Fecal Incontinence / Q000209:etiology / Q000534:rehabilitation; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012003:Rectal Fistula / Q000175:diagnosis; D012007:Rectum / Q000002:abnormalities; D011795:Surveys and Questionnaires
keywords: Anorectal malformations; Anterior anus; Bowel function; Lower urinary tract symptoms