A patient with good surgical anatomy following an anorectal malformation (ARM) repair with fair potential for bowel control

A 4-year-old boy comes to your clinic with a history of anorectal malformation (ARM) (rectoprostatic urethral fistula), tethered cord, and sacral dysgenesis, complaining of daily accidents. His initial ARM repair was done at an outside hospital in his first year of life with preceding colostomy as a newborn and subsequent colostomy closure. His current bowel regimen includes lactulose, polyethylene glycol 3350 (MiraLAX), and Fleet enemas to treat constipation.