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Urinary continence disparities in patients with anorectal malformations. J Pediatr Surg 2022 Jan;57(1):74-79



Pubmed ID




Scopus ID

2-s2.0-85118771148 (requires institutional sign-in at Scopus site)


PURPOSE: While fecal incontinence is a primary concern for many children with anorectal malformations (ARM), urinary incontinence is also prevalent in this population. Racial, ethnic, and socioeconomic disparities in urinary continence have been observed in other conditions, but have not been previously evaluated in ARM. We aimed to evaluate urinary continence and associated demographic and socioeconomic characteristics in individuals with ARM.

METHODS: We performed a multicenter retrospective study of ARM patients evaluated at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC).  We included all patients with ARM 3 years and older. The primary outcome was urinary continence which was categorized as complete (no accidents), daytime (accidents at night), partial (rare or occasional accidents), and none (frequent accidents or no continence). We evaluated for associations between urinary continence and race, sex, age, insurance status, and adoption status, employing Kruskal-Wallis and trend tests. Secondary outcomes included bladder management strategies such as clean intermittent catheterization and continence surgery. P-value < 0.05 was considered significant.

RESULTS: A total of 525 patients with ARM were included. Overall, 48% reported complete urinary continence, and continence was associated with greater age. For school-aged children (age ≥ 5 years), 58% reported complete continence, while 30% reported none. Public insurance and adoption status were associated with decreased likelihood of incontinence.

CONCLUSIONS: We observed a novel finding of disparities in urinary continence for children with ARM related to insurance and adoption status. Further investigation regarding the etiologies of these inequities is needed in order to affect clinical outcomes.

Author List

Ahn JJ, Rice-Townsend SE, Nicassio L, Glazer D, Avansino JR, Lewis KE, Durham MM, Frischer J, Calkins CM, Rentea RM, Ralls M, Fuller M, Wood RJ, Rollins MD, Lee J, Reeder RW, Dickie BH, Saadai P, Cain MP, Merguerian P, Smith CA, Pediatric Colorectal and Pelvic Learning Consortium (PCPLC)


Casey Matthew Calkins MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anorectal Malformations
Child, Preschool
Fecal Incontinence
Retrospective Studies
Urinary Bladder
Urinary Incontinence