Correlation between congenital pelvic floor muscle development assessed by magnetic resonance imaging and postoperative defecation

Pediatr Surg Int. 2024 Apr 10;40(1):104. doi: 10.1007/s00383-024-05691-3.


Objective: Children with congenital anorectal malformation (CAM) experience challenges with defecation. This study aims to assess defecation in preschool-age children with CAM and to evaluate the correlation between pelvic floor muscle developed assessed by magnetic resonance imaging (MRI) and postoperative defecation.

Methods: We collected clinical data and MRI results from 89 male children with CAM. The bowel function scores for children with Perineal (cutaneous) fistula, Rectourethral fistula(Prostatic or Bulbar), and Rectovesical fistula were computed. MRI scans were subjected to image analysis of the striated muscle complex (SMC). The association between pelvic floor muscle score and bowel function score was examined using the Cochran-Armitage Trend Test.

Results: We observed that 77.4% of the SMC scores by MRI for Perineal fistula were good. The Rectourethral fistula SMC score was 40.6% for moderate and 59.4% for poor. The SMC score for Rectovesical fistula was 100% for moderate. Furthermore, 77.4% of patients with Perineal fistula had bowel function scores (BFS) ≥ 17 points. Among those with Rectourethral fistula and Rectovesical fistula, 12.5% and 0 had BFS ≥ 17 points, respectively. An analysis of muscle development and bowel function in patients with Rectovesical fistula, Rectourethral fistula, and Perineal fistula revealed a correlation between SMC development and BFS. Subgroup analysis showed that the Perineal fistula had statistical significance; however, the Rectourethral fistula and Rectovesical fistula were not statistically significant.

Conclusion: A correlation exists between pelvic floor muscle development and postoperative defecation in children with Perineal fistula.

Keywords: Anorectal malformation; Bowel function scores; Magnetic resonance imaging; Perineal fistula; Rectourethral fistula; Rectovesical fistula; Striated muscle complex.

MeSH terms

  • Anal Canal / abnormalities
  • Anal Canal / diagnostic imaging
  • Anal Canal / surgery
  • Anorectal Malformations*
  • Child
  • Child, Preschool
  • Defecation
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Pelvic Floor / diagnostic imaging
  • Pelvic Floor / surgery
  • Rectal Fistula* / surgery
  • Rectum / surgery
  • Urethral Diseases* / surgery
  • Urinary Bladder Fistula*
  • Urinary Fistula* / surgery