Introduction: ARMs and associated abnormalities (AA) are one of the most problematic and common entities in pediatric, Surgery A.A recognition for optimal treatment and best recovery and prevention of disability is very important. About 50% of patient with high type and 25% of low type ARM have associated anomalies, some body single and the others multiple combined anomalies (anomalies in urogenital, musculoskeletal, gastrointestinal, cardiovascular and ophthalmic systems). Among these anomalies, sacral anomaly is very important because has direct effect on the function of urogenital and gastrointestinal system. Recognition of incidence of AA can help the physician to choose the best diagnostic and treatment modalities. This descriptive study in 64 patients with ARMs that have been operated at the pediatric surgery ward, Mashhad University, Medical School ITom1995-1998 and followed for 4-7 years.Result: With regard to the results of physical examination, abdominal and chest X-Ray, ultrasonography, Echocardiography and Spinal cord studies (MRI, C.T Scan...), voiding cystourethrogram (VCUG), Intra venouspyeloureterography (LV.U), distal colostogram, and Barium enema, 32 patients (50%) had associated anomalies (follow up period 4 to 7 years) Of 64 patients in this study; 32 cases (50%) had associated anomalies, mostly of urogenital system (31.2%). The prevalence of other associated anomalies were as bellow: Musculoskeletal system (18.6%), Gastro- intestinal tract (14%), Cardio- vascular system (6.2%), Opthalmic system(6.2%), Soft tissue (3%), Skull (3%), Right lung agenesis(1.5%). This studied the frequency of sex and type of LA in our cases. 62.5% were male, 37.5% female and had, 70.3% high type and 23.4% low type LA; 6.25% cloacal type. Conclusion: All newborns should evaluate for normal anus, if has LA, careful assessment of the genital tracts in females and the genitourinary system in all patients is imperative many children with a high LA have associated spinal cord anomalies, particularly tethered cord. Therefor should be better to evaluate with spinal U.S. & MRI. These infants require evaluations for signs of the VACTERL association including careful cardiac assessment. For these patients Urine analysis (UIA) chest X-Ray, ultrasonography, VCUG, Echocardiography, careful follow up is mandatory.

Background/Purpose: Genitourinary anomalies in patients with imperforate anus are a frequent souree of significant morbidity. Variability of reports on the incidence of associated anomalies with imperforate anus mandates further investigation on this issue.Material and Methods: The case records and imaging studies of 63 patients who underwent reparative surgery for imperforate anus over a 9-year period were retrospectively reviewed.Results: Genitourinary anomalies were seen in 29 patients (16.03%). A voiding cystourethrogram was performed in 36 patients, 11 of whom were shown to have vesicoureteric reflux and 3 of whom required surgical correction. Vesicoureteral reflux was the most prominent urologic anomaly observed. Uretropelvic junction (UPJ) stenosis, hydronephrosis, hypospadiasis, renal agenesis and undescended tests were also common in these patients.Conclusions: Patients with anorectal malformations should be evaluated for urinary tract and spinal problems.

Objective: Genitourinary anomalies in patients with imperforate anus are a frequent source of significant morbidity. Variability of reports on the incidence of associated anomalies with imperforate anus mandates investigation on this issue.Material & Methods: The case records and imaging studies of 105 patients who underwent surgery for imperforate anus over a 10-year period are retrospectively reviewed. Voiding cystouretherography, intra venous pyelography (IVP) and ultrasound were performed in  patients with intermediate or high level anorectal lesions.Findings: During 10 years, there were 48 boys (45.7%) and 57 girls (54.3%) with imperforate anus. Genitourinary anomalies were seen in 34 (48.6%) patients with intermediate or high level anorectal lesions. Eighteen of them (52.9%) were shown to have vesicouretral reflux, only 6 of them required surgical correction. Vesicoureteral reflux was the most prominent urologic anomaly; other anomalies such as ureteropelvic junction (UPJ) stenosis, hydronephrosis, hypospadias, renal agenesis and undescended testis were seen in these series. Conclusion: Patients with anorectal malformations should be evaluated for urinary tract and spinal anomalies.

Objective: The associations between imperforate anus and spinal and vertebral abnormalities and neurologic deficits are well recognized; these neurologic deficits have been considered static rather than progressive. However, recent experience indicates that some patients may develop progressive neurologic problems due to spinal cord lesions that are amenable to neurosurgical correction.Materials & Methods: The medical records of 105 patients with imperforate anus, operated on by us, were retrospectively reviewed from 1996 to 2005. Patient's sex, anorectal type lesion and vertebral or spinal anomalies were determined by ultrasound, excretory urography, voiding cystouretherography (VCUG) and lumbosacral x-ray.Results: A hundred and five cases, consisting 48 (45.7%) boys and 57 (54.3%) girls, with anorectal malformations were studied; 70 patients were in high and intermediate type level, and totally 25 patients (35.7%) with spinal and vertebral anomalies were found in this group.Conclusion: All patients with anorectal malformations (ARM) should be investigated for spinal and vertebral anomalies to improve treatment outcomes in ARM.