Epididymitis in Patients with Anorectal Malformations: A Cause for Urologic Concern

Abstract

ARTICLE INfO ______________________________________________________________ ______________________Introduction: Epididymitis in patients with anorectal malformation (ARM) represents a unique problem because unlike the general population, an underlying urinary tract problem is frequently identified. We review our experience with epididymitis in ARM population with an emphasis on examining urologic outcomes. Materials and Methods:We performed a retrospective review of male patients with ARM cared for from 1980 to 2010. Clinical and pathologic variables recorded included age at presentation, recurrence, associated urologic anomalies, incidence of ureteral fusion with mesonephric ductal structures, glomerular filtration rate and urodynamic parameters.Results: Twenty-six patients were identified with documented episodes of epididymitis.Renal injury was noted in five patients (19%), all of whom were diagnosed with neurogenic bladder (NGB) several years after anorectoplasty. NGB was found in ten patients (38%) in our series. Ectopic insertion of ureter into a mesonephric ductal structure was discovered in five patients (19%). Twelve patients (46%) had recurrent episodes of epididymitis, with seven of these patients (58%) being diagnosed with NGB. Two patients in the pubertal group presented with a history of epididymitis and complained of ejaculatory pain. Conclusion: Epididymitis in a patient with ARM warrants a comprehensive urologic investigation, particularly in recurrent episodes. Attempts at surgical intervention (e.g. vasectomy) should be avoided until functional assessment of the urinary tract has occurred. Failure to recognize this association may lead to potentially avoidable complications and morbidity. Long term urological follow up of these patients is warranted to identify at risk patients and minimize renal deterioration

Sonography for an Imperforate Anus: Approach, Timing of the Examination, and Evaluation of the Type of Imperforate Anus and Associated Anomalies

“…Genitourinary anomalies are common in patients with an imperforate anus, with a reported incidence of 10% to 52% . Epididymitis has also been reported to occur in 3% of male patients with an imperforate anus . In female patients, uterine and vaginal anomalies have been reported .…”

Solitary functioning kidney in high anorectal malformation

“…The common embryogenesis of mesonephric duct derivatives explains the association between structural facts such as ipsilateral renal agenesis, ectopic opening of verumontanum near the bladder neck, abnormal opening of ureter into vas and their functional implications of congenital neurovesical dysfunction, vesicoureteral reflux, and urethrovasal reflux. [12] The proximity of the rectourinary fistulous and vasal opening in the posterior urethra and surgical instrumentation around the veru and bladder neck during surgery for anorectal malformation with prostatic or vesical fistulas adds to the risk of an epididymo-orchitis. Recurrent epididymitis in a patient with anorectal malformation warrants a comprehensive urologic investigation;[12] it is often coexistent with or predates an ascending VUR into the solitary renal unit.…”

“…[12] The proximity of the rectourinary fistulous and vasal opening in the posterior urethra and surgical instrumentation around the veru and bladder neck during surgery for anorectal malformation with prostatic or vesical fistulas adds to the risk of an epididymo-orchitis. Recurrent epididymitis in a patient with anorectal malformation warrants a comprehensive urologic investigation;[12] it is often coexistent with or predates an ascending VUR into the solitary renal unit.…”

Scrotal abscess: Varied etiology, associations, and management

“…Long-term surveillance of urological system is required in these children. [ 18 ] ARM cases developed UER due to acquired stricture and neurogenic bladder. Urogenital infections settled after clean intermittent catheterization (CIC).…”