Urinary Problems Associated with Imperforate Anus

  • Erich SorantinEmail author
  • Michael E. Höllwarth
  • Sandra Abou Samaan
Part of the Medical Radiology book series (MEDRAD)


The term “imperforate anus” includes all kinds of anorectal malformations: from covering of the anus by a thin skin membrane to high anorectal atresia – with or without a fistula into the urethra or the bladder – to cloacal anomalies in females. Overall incidence is 1 in 5000 live births with a slight male predominance (Alamo et al. 2013).


  1. Alamo L, Meyrat BJ, Meuwly JY, Meuli RA, Gudinchet F (2013) Anorectal malformations: finding the pathway out of the labyrinth. Radiographics 33:491–512CrossRefPubMedGoogle Scholar
  2. Berdon WE, Hochberg B, Baker DH, Grossman H, Santulli TV (1966) The association of lumbosacral spine and genitourinary anomalies with imperforate anus. Am J Radiol 98:181–191Google Scholar
  3. Boemers TML, Bax KMA, Rövekamp MH, van Gool JD (1995) The effect of posterior sagittal anorectoplasty and its variants on lower urinary tract function in children with anorectal malformations. J Urol 153:191–193CrossRefPubMedGoogle Scholar
  4. Boemers TML, de Jong TPVM, van Gool JD, Bax KMA (1996a) Urologic problems in anorectal malformations. 1. Urodynamic findings and significance of sacral anomalies. J Pediatr Surg 31:407–410CrossRefPubMedGoogle Scholar
  5. Boemers TML, de Jong TPVM, van Gool JD, Bax KMA (1996b) Urologic problems in anorectal malformations. 2. Functional urologic sequelae. J Pediatr Surg 31:634–637CrossRefPubMedGoogle Scholar
  6. Boemers TML, Beek FJA, Bax NMA (1999) Guidelines for urological screening and initial management of lower urinary tract dysfunction in children with anorectal malformations – the ARGUS protocol. BJU Int 83:662–671CrossRefPubMedGoogle Scholar
  7. Carson JA, Barnes PD, Tunell WP (1984) Imperforate anus: the neurologic implication of sacral abnormalities. J Pediatr Surg 19:838–842CrossRefPubMedGoogle Scholar
  8. Duhamel B (1961) From the mermaid to anal imperforation: the syndrome of caudal regression. Arch Dis Child 36:152–155CrossRefPubMedPubMedCentralGoogle Scholar
  9. Elliott GB, Tredwell SJ, Elliott KA (1970) The notochord as an abnormal organizer in production of congenital intestinal defect. Am J Radiol 110:628–634Google Scholar
  10. Gartner L, Peiris C, Marshall M, Taylor SA, Halligan S (2013) Congenital anorectal atresia: MR imaging of late post-operative appearances in adult patients with anal incontinence. Eur Radiol 23:3318–3324CrossRefPubMedGoogle Scholar
  11. Georgeson KE, Inge TH, Albanese CT (2000) Laparoscopically assisted anorectal pull-through for high imperforate anus – a new technique. J Pediatr Surg 35:927–930CrossRefPubMedGoogle Scholar
  12. Greenfield SP, Fera M (1991) Urodynamic evaluation of the patient with an imperforate anus: a prospective study. J Urol 146:539–541CrossRefPubMedGoogle Scholar
  13. Golonka NR, Haga LJ, Keating RP, Eichelberger MR, Gilbert JC, Hartman GE, Newman KD et al (2002) Routine MRI evaluation of low imperforate anus reveals unexpected high incidence of tethered spinal cord. J Pediatr Surg 37:966–969; discussion 999CrossRefPubMedGoogle Scholar
  14. Haber HP, Seitz G, Warmann SW, Fuchs J (2007) Transperineal sonography for determination of the type of imperforate anus. AJR Am J Roentgenol 189:1525–1529CrossRefPubMedGoogle Scholar
  15. Hoekstra WJ, Scholtmeijer RJ, Molenaar JC (1983) Urogenital tract abnormalities associated with congenital anorectal anomalies. J Urol 130:962–963CrossRefPubMedGoogle Scholar
  16. Holschneider AM, Kraeft H, Scholtissek C (1982) Urodynamische Untersuchungen von Blasenentleerungsstörungen bei Analatresie und Morbus Hirschsprung. Z Kinderchir 35:64–68PubMedGoogle Scholar
  17. Höllwarth M, Menardi G (1983) Begleitmißbildungen bei anorektalen Anomalien. In: von Kapherr H (ed) Anorektale Fehlbildungen. Fischer, Stuttgart, pp 63–67Google Scholar
  18. Kakizaki H, Nonomura K, Asano Y (1994) Preexisting neurogenic voiding dysfunction in children with imperforate anus: problems in management. J Urol 151:1041–1044CrossRefPubMedGoogle Scholar
  19. Karrer FM, Flannery AM, Nelson MD (1988) Anorectal malformations: evaluation of associated spinal dysraphic syndromes. J Pediatr Surg 23:45–48CrossRefPubMedGoogle Scholar
  20. Lobo LM (2015) Recommendation for an imaging algorithm in neonatal and childhood ano-rectal/cloacal malformation. Pediatr Radiol 45:310Google Scholar
  21. McLorie GA, Sheldon CA, Fleisher M (1987) The genitourinary system in patients with imperforate anus. J Pediatr Surg 22:1100–1104CrossRefPubMedGoogle Scholar
  22. Moore TC, Lawrence EA (1952) Congenital malformations of the rectum and anus: associated anomalies encountered in a series of 120 cases. Surg Gynecol Obstet 95:281–284PubMedGoogle Scholar
  23. Murphy F, Puri P, Hutson JM (2006) Incidence and frequency of different types, and classification of anorectal malformations. In: Holschneider AM, Hutson JM (eds) Anorectal malformation in children. Springer, Heidelberg, pp 163–184Google Scholar
  24. Pang D (1993) Sacral agenesis and caudal spinal cord malformations. Neurosurgery 32:755–758CrossRefPubMedGoogle Scholar
  25. Parrott TS (1985) Urologic implications of anorectal malformations. Urol Clin North Am 12:13–21PubMedGoogle Scholar
  26. Pellerin D, Bertin P (1967) Genito-urinary malformations and vertebral anomalies in ano-rectal malformations. Z Kinderchir 4:375–383Google Scholar
  27. Pena A (1967) Posterior sagittal anorectoplasty: results in management of 332 cases of anorectal malformations. Pediatr Surg Int 3:94–104Google Scholar
  28. Ralph DJ, Woodhouse CRJ, Ransley PG (1992) The management of the neuropathic bladder in adolescents with imperforate anus. J Urol 148:366–368CrossRefPubMedGoogle Scholar
  29. Riccabona M, Lobo ML, Willi U, Avni F, Damasio B, Ording-Mueller LS, Blickman J, Darge K, Papadopoulou F, Vivier PH et al (2014) ESPR uroradiology task force and ESUR Paediatric Work Group – Imaging recommendations in paediatric uroradiology, part VI: childhood renal biopsy and imaging of neonatal and infant genital tract. Minutes from the task force session at the annual ESPR Meeting 2012 in Athens on childhood renal biopsy and imaging neonatal genitalia. Pediatr Radiol 44:496–502CrossRefPubMedGoogle Scholar
  30. Riccabona M, Lobo ML, Ording-Muller LS, Augdal TA, Avni FE, Blickman J, Bruno C, Damasio B, Darge K, Ntoulia A, Papadopoulou F, Vivier PH (2017) ESPR abdominal (GU and GI) imaging task force – imaging recommendations in paediatric uroradiology, part IX: imaging in anorectal and cloacal malformation, imaging in childhood ovarian torsion, and efforts in standardising pediatric uroradiology terminology. Report on the mini-symposium at the ESPR meeting in Graz, June 2015. Pediatr Radiol 47:1369–1380. Epub 2017 Aug 29CrossRefPubMedPubMedCentralGoogle Scholar
  31. Rivosecchi M, Lucchetti MC, Zaccara A (1995) Spinal dysraphism detected by magnetic resonance imaging in patients with anorectal anomalies: incidence and clinical significance. J Pediatr Surg 30:488–490CrossRefPubMedGoogle Scholar
  32. Stephens FD, Smith ED (1971) Ano-rectal malformations in children. Year Book, ChicagoGoogle Scholar
  33. Stephens FD, Smith ED (1986) Classification, identification, and assessment of surgical treatment of anorectal anomalies. Pediatr Surg Int 1:200–205CrossRefGoogle Scholar
  34. Wiener ES, Kiesewetter WB (1973) Urologic abnormalities associated with imperforate anus. J Pediatr Surg 8:151–157CrossRefPubMedGoogle Scholar
  35. Wilcox DT, Warne SA (2006) Urological problems in children with anorectal malformations. In: Holschneider AM, Hutson JM (eds) Anorectal malformations in children. Springer, Heidelberg, pp 269–279Google Scholar
  36. Yeung CK, Kiely EM (1991) Low anorectal anomalies: a critical appraisal. Pediatr Surg Int 6:333–335Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Erich Sorantin
    • 1
    Email author
  • Michael E. Höllwarth
    • 2
  • Sandra Abou Samaan
    • 3
  1. 1.Department of Radiology, Division of Pediatric RadiologyMedical University GrazGrazAustria
  2. 2.Department of Pediatric and Adolescent SurgeryMedical University GrazGrazAustria
  3. 3.Department of RadiologyHamad General HospitalDohaQatar

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