{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T01:11:40Z","timestamp":1792458700837,"version":"4.5.0"},"reference-count":24,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T00:00:00Z","timestamp":1754611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Anorectal malformations (ARMs) are rare congenital anomalies requiring surgical correction and long-term multidisciplinary care. Despite advances in surgical techniques like posterior sagittal anorectoplasty (PSARP), patients often experience ongoing issues with bowel and urinary function and psychosocial well-being. Aim: To evaluate the long-term outcomes of bowel function, urinary function, and quality of life in patients born with anorectal malformation and treated at our center. Methods: A cross-sectional study evaluated 55 ARM patients treated at the University Hospital of Palermo between 2002 and 2020. Data on clinical characteristics, surgical management, bowel and urinary function, and quality of life were collected using the following validated tools: Rintala Bowel Function Score, PedsQL Family Impact Module, Fecal Incontinence Quality of Life Score, and Lower Urinary Tract Symptoms Questionnaire. Statistical analysis was performed using Fisher\u2019s exact test and ANOVA. Results: Excellent bowel function was observed in 44% of patients, particularly those with low-type ARMs. A bowel management program (BMP) was required in 62% of cases, though 44% of these patients, especially adolescents, showed poor adherence. BMP non-adherence significantly correlated with lower quality of life and worse bowel function (p &lt; 0.01). Bladder dysfunction was noted in 24% of patients, mainly younger ones. Conclusions: Tailored BMPs and transition care are important for long-term success in ARM patients. Adherence to BMPs improves continence and quality of life, highlighting the need for continuous, multidisciplinary follow-up from childhood into adulthood.<\/jats:p>","DOI":"10.3390\/children12081042","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T13:20:09Z","timestamp":1754659209000},"page":"1042","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Long-Term Bowel and Urinary Function Outcomes and Quality of Life in Patients with Anorectal Malformations: 20 Years of Experience"],"prefix":"10.3390","volume":"12","author":[{"given":"Fabio","family":"Baldanza","sequence":"first","affiliation":[{"name":"Pediatric Surgical Unit, Department Health Promotion of Mother and Child Care Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Grasso","sequence":"additional","affiliation":[{"name":"Pediatric Surgical Unit, Department Health Promotion of Mother and Child Care Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3187-1901","authenticated-orcid":false,"given":"Marco","family":"Pensabene","sequence":"additional","affiliation":[{"name":"Pediatric Surgical Unit, Department Health Promotion of Mother and Child Care Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Sergio","sequence":"additional","affiliation":[{"name":"Pediatric Surgical Unit, Department Health Promotion of Mother and Child Care Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Rita","family":"Di Pace","sequence":"additional","affiliation":[{"name":"Pediatric Surgical Unit, Department Health Promotion of Mother and Child Care Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"van de Putte, R., Dworschak, G.C., Brosens, E., Reutter, H.M., Marcelis, C.L.M., Acuna-Hidalgo, R., Kurtas, N.E., Steehouwer, M., Dunwoodie, S.L., and Schmiedeke, E. (2020). A Genetics-First Approach Revealed Monogenic Disorders in Patients with ARM and VACTERL Anomalies. Front. Pediatr., 8.","DOI":"10.3389\/fped.2020.00310"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/S0022-3468(82)80126-7","article-title":"Posterior sagittal anorectoplasty","volume":"17","author":"deVries","year":"1982","journal-title":"J. Pediatr. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1053\/j.sempedsurg.2017.09.010","article-title":"Long-term bowel function, quality of life and sexual function in patients with anorectal malformations treated during the PSARP era","volume":"26","author":"Kyrklund","year":"2017","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1007\/s00383-023-05516-9","article-title":"Gastrointestinal quality of life and bowel function in adults born with anorectal malformation and hirschsprung disease","volume":"39","author":"Wehrli","year":"2023","journal-title":"Pediatr. Surg. Int."},{"key":"ref_5","first-page":"35","article-title":"Anorectal malformations","volume":"4","author":"Pena","year":"1995","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_6","unstructured":"Holschneider, A., and Hutson, J. (2006). Incidence and Frequency of Different Types, and Classification of Anorectal Malformations. Anorectal Malformations in Children, Springer."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/S0022-3468(97)90628-X","article-title":"Do children with repaired low anorectal malformations have normal bowel function?","volume":"32","author":"Rintala","year":"1997","journal-title":"J. Pediatr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/0022-3468(95)90064-0","article-title":"Is normal bowel function possible after repair of intermediate and high anorectal malformations?","volume":"30","author":"Rintala","year":"1995","journal-title":"J. Pediatr. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/1477-7525-2-55","article-title":"The PedsQL Family Impact Module: Preliminary reliability and validity","volume":"2","author":"Varni","year":"2004","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/BF02237236","article-title":"Fecal Incontinence Quality of Life Scale: Quality of life instrument for patients with fecal incontinence","volume":"43","author":"Rockwood","year":"2000","journal-title":"Dis. Colon Rectum"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s00383-024-05766-1","article-title":"Urological outcomes in adult females born with anorectal malformation or Hirschsprung disease","volume":"40","author":"Wehrli","year":"2024","journal-title":"Pediatr. Surg. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.jpedsurg.2016.10.051","article-title":"Outcome in adults with anorectal malformations in relation to modern classification\u2014Which patients do we need to follow beyond childhood?","volume":"52","author":"Danielson","year":"2017","journal-title":"J. Pediatr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1016\/j.jpedsurg.2017.12.020","article-title":"Continence after posterior sagittal anorectoplasty for anorectal malformations: Comparison of different scores","volume":"53","author":"Brisighelli","year":"2018","journal-title":"J. Pediatr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bokova, E., Svetanoff, W.J., Lopez, J.J., Levitt, M.A., and Rentea, R.M. (2023). State of the Art Bowel Management for Pediatric Colorectal Problems: Anorectal Malformations. Children, 10.","DOI":"10.3390\/children10050846"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.jpedsurg.2009.10.041","article-title":"Long-term functional outcome and quality of life in patients with high imperforate anus","volume":"45","author":"Hashish","year":"2010","journal-title":"J. Pediatr. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1016\/j.jpedsurg.2012.01.068","article-title":"Long-term disease-specific quality of life in children and adolescent patients with ARM","volume":"47","author":"Grano","year":"2012","journal-title":"J. Pediatr. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Pelizzo, G., Canonica, C.P.M., Destro, F., Meroni, M., Rizzo, D., Canazza, L., Selvaggio, G.G.O., Durante, E., Zuccotti, G., and Calcaterra, V. (2023). Anorectal Malformations: Ideal Surgery Timing to Reduce Incontinence and Optimize QoL. Children, 10.","DOI":"10.3390\/children10020404"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1590\/1806-9282.62.06.544","article-title":"Long-term evaluation of fecal continence and quality of life in patients operated for anorectal malformations","volume":"62","author":"Tannuri","year":"2016","journal-title":"Rev. Assoc. Med. Bras."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1016\/j.jpedsurg.2016.03.011","article-title":"Long term follow-up and transition of care in anorectal malformations: An international survey","volume":"51","author":"Giuliani","year":"2016","journal-title":"J. Pediatr. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s00383-018-4401-7","article-title":"Transition of care: A growing concern in adult patients born with colorectal anomalies","volume":"35","author":"Acker","year":"2018","journal-title":"Pediatr. Surg. Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1097\/DCR.0000000000001033","article-title":"Challenges in Transition of Care for Patients with Anorectal Malformations: A Systematic Review and Recommendations for Comprehensive Care","volume":"61","author":"Cairo","year":"2018","journal-title":"Dis. Colon Rectum"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1016\/j.jpedsurg.2023.04.006","article-title":"Long-Term Male Sexual Function and Fecal Incontinence Outcomes for Adult Patients with Hirschsprung Disease or Anorectal Malformation","volume":"58","author":"Trinidad","year":"2023","journal-title":"J. Pediatr. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"150.e1","DOI":"10.1016\/j.jpurol.2022.01.019","article-title":"Long-term urology outcomes of anorectal malformation","volume":"18","author":"Chong","year":"2022","journal-title":"J. Pediatr. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.1016\/j.jpedsurg.2017.06.008","article-title":"Transition of care in patients with anorectal malformations: Consensus by the ARM-net consortium","volume":"52","author":"Giuliani","year":"2017","journal-title":"J. Pediatr. Surg."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/8\/1042\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:26:33Z","timestamp":1760034393000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/8\/1042"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,8]]},"references-count":24,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["children12081042"],"URL":"https:\/\/doi.org\/10.3390\/children12081042","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,8]]}}}