title: Early reported rectal sensation predicts continence in anorectal anomalies.
abstract: BACKGROUND
  Straining at stool is an automatic reflex in babies and implies the presence of rectal sensation. We hypothesised that early reported rectal sensation would predict future continence in children with anorectal anomalies.
  
  
  OBJECTIVE
  The aim of this study is to determine if early straining at stool was a useful predictor of future continence in infants born with high anorectal malformations.
  
  
  METHODS
  A retrospective case note review of prospectively collected clinical information was performed with institutional review board approval. All patients with intermediate/high anorectal malformation operated on by a single surgeon from 1984 to 2010 were included. After stoma closure, parents were asked: The responses were noted within the first year of stoma closure and then all patients were followed up until they were at least 3 ½years old and continence could be assessed using the Krickenbeck outcome classification. Data were compared using Fisher's exact test and sensitivity, specificity and positive predictive value (PPV) were calculated.
  
  
  RESULTS
  Forty-eight patients were included in the study. Sixteen (33%) were female (12 cloacal malformation, 3 rectovaginal fistula, 1 rectal atresia) and 32 (66%) were male (6 rectovesical fistulae, 22 rectourethral fistulae, 4 no fistula). Median follow-up was 9.7years (range 3.5-17.9). Twenty-one children were noted by their parents to exhibit early straining at stool after stoma closure. Twenty of them achieved long term continence. The sensitivity of early straining as a predictor for long term continence was 77%, specificity 95% and positive predictive value 95%.
  
  
  CONCLUSIONS
  The presence of early rectal sensation reported by parents is a good predictor of long term continence. This allows more informed discussion with families in the early years of life.
authors.affiliation: Department of Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK. Electronic address: clareskerritt@nhs.net.
authors.forename: Clare
authors.initials: C
authors.lastname: Skerritt
authors.affiliation: Department of Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tyraskis
authors.affiliation: Department of Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Rees
authors.affiliation: Department of Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK.
authors.forename: Iram
authors.initials: I
authors.lastname: Cockar
authors.affiliation: Department of Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Kiely
mesh_terms: D001003:Anal Canal / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D002675:Child, Preschool; D005242:Fecal Incontinence / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D012007:Rectum / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D012677:Sensation; D012680:Sensitivity and Specificity
keywords: Anorectal anomalies; Anorectal malformation; Faecal continence; Imperforate anus; Rectal sensation