European Journal of Pediatric Surgery ( IF 1.8 ) Pub Date : 2022-01-24 , DOI: 10.1055/s-0042-1742300 Anna Morandi 1 , Maria Fanjul 2 , Barbara Daniela Iacobelli 3 , Inbal Samuk 4 , Dalia Aminoff 5 , Paola Midrio 6 , Ivo de Blaauw 7 , Eberhard Schmiedeke 8 , Alessio Pini Prato 9 , Wout Feitz 10 , Hendrik J J van der Steeg 7 , Dario Guido Minoli 11 , Cornelius E J Sloots 12 , Francesco Fascetti-Leon 13 , Igor Makedonsky 14 , Araceli Garcia 15 , Pernilla Stenström 16
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.
中文翻译:
附睾-睾丸炎对肛门直肠畸形患者泌尿系统的影响:一项 ARM-Net 联盟研究
简介 旨在调查 ARM-Net 联盟在管理肛门直肠畸形 (ARM) 患者的附睾睾丸炎 (EO) 方面的当前经验,并确定特定的风险因素和泌尿外科护理参与的必要性。
材料和方法 我们回顾性收集了 2015 年至 2019 年 ARM 患者的 EO 数据。收集并分析了泌尿外科方面、ARM 类型、手术入路、相关异常、诊断和治疗的 EO 的数据。
结果 12 个中心报告了 29 名患者。26 名 EO 患者 (90%) 患有 ARM 伴直肠泌尿瘘。首次 EO 的中位年龄为 2 岁(范围:15 天至 27 岁)。20 名患者 (69%) 经历了多次 EO,并且 60% 的复发是同侧的。相关的泌尿系统异常包括膀胱输尿管反流 (48%)、尿道异常 (41%)、神经源性膀胱 (41%) 和异位输精管 (10%)。69% 的患者在 EO 期间尿培养呈阳性。EO 用抗生素治疗 (90%),将手术探查限制在 14%。复发的预防包括手术(膨胀剂 15%、输精管结扎术 15% 和睾丸切除术 5%)和预防性使用抗生素 (20%)。
结论 泌尿外科医生可能会遇到ARM患者中出现EO的患者,尿培养常呈阳性。大多数 ARM 患者需要进行适当的泌尿科检查,以识别和治疗潜在的危险因素。为儿科外科医生和泌尿科医生之间的密切合作建议了一个实用的检查方案。