Eur J Pediatr Surg 2022; 32(06): 504-511
DOI: 10.1055/s-0042-1742300
Original Article

Urological Impact of Epididymo-orchitis in Patients with Anorectal Malformation: An ARM-Net Consortium Study

Anna Morandi
1   Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
,
Maria Fanjul
2   Department of Pediatric Surgery, Hospital Gregorio Marañón, Madrid, Spain
,
Barbara Daniela Iacobelli
3   Newborn Surgery Unit, Department of Medical and Surgical Neonatology, Research Institute, Bambino Gesù Children's Hospital, Rome, Italy
,
Inbal Samuk
4   Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Dalia Aminoff
5   AIMAR-Italian Patients' and Parents' Organization for Anorectal Malformation, Rome, Italy
,
Paola Midrio
6   Pediatric Surgery Unit, Cà Foncello Hospital, Treviso, Italy
,
Ivo de Blaauw 
7   Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
,
Eberhard Schmiedeke 
8   Clinic for Paediatric Surgery and Paediatric Urology, Klinikum Bremen-Mitte, Bremen, Germany
,
Alessio Pini Prato 
9   Pediatric Surgery Unit, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
,
Wout Feitz
10   Division of Paediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
,
Hendrik J. J. van der Steeg
7   Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
,
Dario Guido Minoli 
11   Pediatric Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
,
Cornelius E. J. Sloots
12   Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
,
Francesco Fascetti-Leon
13   Pediatric Surgery Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
,
Igor Makedonsky
14   Department of Pediatric Surgery, Rudnev Dnipropetrovsk Specialized Clinical Medical Center for Mother and Child Health, Dnipro, Ukraine
,
Araceli Garcia
15   Pediatric Surgery Unit, University Hospital 12 de Octubre, Madrid, Spain
,
Pernilla Stenström 
16   Department of Pediatric Surgery, Skane University Hospital, Lund University, Lund, Sweden
› Author Affiliations Funding None.
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Abstract

Introduction To investigate the current experience of the ARM-Net Consortium in the management of epididymo-orchitis (EO) in patients with anorectal malformations (ARMs), and to identify specific risk factors and the need for urological care involvement.

Materials and Methods We retrospectively collected data of EO in patients with ARM between 2015 and 2019. Data on urological aspects, ARM type, surgical approach, associated anomalies, diagnosis, and treatment of EO were collected and analyzed.

Results Twenty-nine patients were reported by 12 centers. Twenty-six patients with EO (90%) had ARM with a rectourinary fistula. Median age at first EO was 2 years (range: 15 days–27 years). Twenty patients (69%) experienced multiple EO, and 60% of recurrences were ipsilateral. Associated urological anomalies included vesicoureteral reflux (48%), urethral anomalies (41%), neurogenic bladder (41%), and ectopic vas (10%). A positive urine culture during EO was present in 69%. EO was treated with antibiotics (90%), limiting surgical exploration to 14%. Prevention of recurrences included surgery (bulking agents 15%, vasectomy 15%, and orchiectomy 5%) and antibiotic prophylaxis (20%).

Conclusion Urologists may encounter patients with EO in ARM patients, frequently with positive urine culture. An appropriate urologic work-up for most ARM patients is necessary to identify and treat underlying risk factors. A practical scheme for the work-up is suggested for a close collaboration between pediatric surgeons and urologists.

Keywords

urology - LUTD - anorectal malformation - epididymo-orchitis - acute scrotum


Publication History

Received: 21 September 2021

Accepted: 13 December 2021

Article published online:
24 January 2022

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