title: Outcome in anorectal malformation type rectovesical fistula: a nationwide cohort study in The Netherlands.
abstract: OBJECTIVE
  Outcomes of patients with an ARM-type rectovesical fistula are scarcely reported in medical literature. This study evaluates associated congenital anomalies and long-term colorectal and urological outcome in this group of ARM-patients.
  
  
  METHODS
  A retrospective Dutch cohort study on patients treated between 1983 and 2014 was performed. Associated congenital anomalies were documented, and colorectal and urological outcome recorded at five and ten years of follow-up.
  
  
  RESULTS
  Eighteen patients were included, with a mean follow-up of 10.8years. Associated congenital anomalies were observed in 89% of the patients, 61% considered a VACTERL-association. Total sacral agenesis was present in 17% of our patients. At five and ten years follow-up voluntary bowel movements were described in 80% and 50%, constipation in 80% and 87%, and soiling in 42% and 63% of the patients, respectively. Bowel management was needed in 90% and one patient had a definitive colostomy. PSARP was the surgical reconstructive procedure in 83%. Urological outcome showed 14 patients (81%) to be continent. No kidney transplantations were needed.
  
  
  CONCLUSIONS
  In our national cohort of ARM-patients type rectovesical fistula that included a significant proportion of patients with major sacral anomalies, the vast majority remained reliant on bowel management to be clean after ten years follow-up, despite "modern" PSARP-repair. Continence for urine is achieved in the majority of patients, and end-stage kidney failure is rare.
authors.affiliation: Department of Surgery-Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands. Electronic address: herjan.vandersteeg@radboudumc.nl.
authors.forename: H J J
authors.initials: HJ
authors.lastname: van der Steeg
authors.affiliation: Department of Surgery-Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands.
authors.forename: S M B I
authors.initials: SM
authors.lastname: Botden
authors.affiliation: Department of Pediatric Surgery, Erasmus-MC Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: C E J
authors.initials: CE
authors.lastname: Sloots
authors.affiliation: Department of Pediatric Surgery, Emma Children's Hospital, AMC and VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: A F W
authors.initials: AF
authors.lastname: van der Steeg
authors.affiliation: Department of Pediatric Surgery, University Medical Center, Groningen, The Netherlands.
authors.forename: P M A
authors.initials: PM
authors.lastname: Broens
authors.affiliation: Department of Pediatric Surgery, Emma Children's Hospital, AMC and VU University Medical Center, Amsterdam, The Netherlands; Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: L W E
authors.initials: LW
authors.lastname: van Heurn
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.
authors.forename: D V
authors.initials: DV
authors.lastname: Travassos
authors.affiliation: Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: I A L M
authors.initials: IA
authors.lastname: van Rooij
authors.affiliation: Department of Surgery-Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: de Blaauw
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery; D001003:Anal Canal / Q000002:abnormalities; D000071056:Anorectal Malformations / Q000601:surgery*; D001006:Anus, Imperforate / Q000601:surgery; D002675:Child, Preschool; D003125:Colostomy; D003248:Constipation / Q000209:etiology; D003672:Defecation; D004947:Esophagus / Q000002:abnormalities; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital; D006801:Humans; D007668:Kidney / Q000002:abnormalities; D017880:Limb Deformities, Congenital; D008297:Male; D009426:Netherlands; D011183:Postoperative Complications; D012003:Rectal Fistula / Q000601:surgery*; D012189:Retrospective Studies; D013131:Spine / Q000002:abnormalities; D014132:Trachea / Q000002:abnormalities; D001747:Urinary Bladder Fistula / Q000601:surgery*
keywords: Anorectal malformation (ARM); Bladder neck fistula; Colorectal outcome; Long-term follow-up; Rectovesical fistula; Urological outcome