title: Prevalence of Active Long-term Problems in Patients With Anorectal Malformations: A Systematic Review.
abstract: BACKGROUND
  Anorectal malformations are a spectrum of congenital anomalies of the rectum with high infantile survival rates and variable outcomes. Long-term (>10 years old) active problems associated with this condition have been poorly investigated.
  
  
  OBJECTIVE
  The purpose of this review was to systematically define the prevalence of the most common active long-term problems in patients with a history of anorectal malformation repair.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane Library were searched electronically using the OVID search platform.
  
  
  METHODS
  Original articles from August 1, 1994, to October 20, 2015, that included outcome data for patients aged ≥10 years with anorectal malformation. Cloaca was excluded from the study.
  
  
  METHODS
  Prevalence estimates of anorectal malformations were obtained from published articles. CIs were ascertained in the logit scale after transforming prevalence into log odds and were then transformed into the original scale. The same method was used for subgroup analysis investigating high and low anorectal malformations.
  
  
  METHODS
  The overall prevalences of fecal, urinary, and sexual dysfunction were analyzed.
  
  
  RESULTS
  Twelve studies including 455 patients with a history of anorectal malformation repair were included for analysis. The range of reported prevalence of long-term active problems was as follows: fecal incontinence, 16.7% to 76.7%; chronic constipation, 22.2% to 86.7%; urinary incontinence, 1.7% to 30.5%; ejaculatory dysfunction, 15.6% to 41.2%; and erectile dysfunction, 5.6% to 11.8%.
  
  
  CONCLUSIONS
  The study was limited by its retrospective, small size; multiple complex associated anomalies often not reported; and heterogeneous composition of patients with limited stratification analysis.
  
  
  CONCLUSIONS
  There is an overall high prevalence of active long-term issues in adolescents and young adults with anorectal malformations. Additional multicenter research is needed to define characteristics and predictors of long-term outcome, to implement effective follow-up, and to transition to adult health care.
authors.affiliation: 1 Department of Pediatric and Neonatal Surgery, St. George's University Hospitals, National Health Service Foundation Trust, London, United Kingdom 2 Population Health Research Institute, St. George's University of London, London, United Kingdom.
authors.forename: Laurie
authors.initials: L
authors.lastname: Rigueros Springford
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Connor
authors.forename: Katie
authors.initials: K
authors.lastname: Jones
authors.forename: Venediktos V
authors.initials: VV
authors.lastname: Kapetanakis
authors.forename: Stefano
authors.initials: S
authors.lastname: Giuliani
mesh_terms: D000293:Adolescent; D000071056:Anorectal Malformations / Q000150:complications*; D003248:Constipation / Q000453:epidemiology / Q000209:etiology*; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015995:Prevalence; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology / Q000209:etiology*; D001750:Urinary Bladder, Neurogenic / Q000453:epidemiology / Q000209:etiology*; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult