Bladder Height-to-Width Ratio as a Predictor of Future Neurogenic Bladder Dysfunction in Patients With Anorectal Malformations.

Introduction This retrospective study evaluated the bladder height-to-width ratio (HWR) in neonates with anorectal malformations (ARMs) to assess its potential role as a predictor of neurogenic bladder dysfunction (NBD). Objectives This study aimed to evaluate whether HWR can serve as a predictor of future NBD in neonates with high and intermediate ARMs. Study design We retrospectively reviewed the medical records of 48 patients with high or intermediate ARMs who underwent laparoscopic-assisted anorectoplasty at our institution between January 2000 and December 2018. Maximum HWRs were measured using cystography performed shortly after birth. Patients were categorized into two groups: the NBD group (n = 8, requiring clean intermittent catheterization (CIC)) and the non-NBD group (n = 40, not requiring CIC). Additionally, odds ratios (ORs) were calculated for spinal abnormalities, sacral malformations, genetic anomalies, and ARM type. Results The NBD group included eight patients who required CIC, while the non-NBD group comprised 40 patients who did not. The median age of all patients was 11.56 years (7.8 years in the NBD group and 12.27 years in the non-NBD group). The NBD group had a significantly higher median HWR compared to the non-NBD group (1.942 vs. 1.432, p = 0.000029). An HWR cutoff of 1.842 yielded a sensitivity of 92.5% and a specificity of 75% for identifying patients who required CIC, with an area under the curve (AUC) of 0.888. Among the assessed variables, only sacral malformations showed a statistically significant association with NBD (OR 10.76, p = 0.0006). Conclusion Our findings suggest that neonates with high and intermediate ARMs already exhibit elevated HWR shortly after birth. HWR may thus serve as an early screening tool for predicting NBD in this population. An HWR threshold of 1.842 was identified as a potential cutoff for risk stratification. Furthermore, sacral malformations were strongly associated with NBD among patients with ARMs. HWR measurement could therefore be integrated into early diagnostic evaluation to facilitate timely multidisciplinary management.