Abstract
Purpose
The ideal colostomy type indicated for patients with anorectal malformation (ARM) is disputed. The aim of this study was to analyze the clinical factors associated with urinary tract infection (UTI) prior to corrective surgery in male ARM without perineal fistula having undergone diverting enterostomy.
Methods
A retrospective review of patients diagnosed with ARM and surgically managed at our center from January 2011 to December 2019 was performed. Logistic regression was used to analyze the association between clinical factors and UTI.
Results
Eighty boys with ARM without perineal fistula underwent diverting enterostomy and subsequent corrective surgery via laparoscopic-assisted anorectal pull-through. A sigmoid loop colostomy was most often performed (70 patients, 87.5%). Twenty-nine patients (36.3%) were diagnosed with vesicoureteral reflux (VUR), including 14 (48.3%) with febrile UTIs. Six patients had other concomitant genitourinary anomalies excluding VUR. Multivariate logistic regression analysis revealed the presence of VUR as the only independent factor associated with the occurrence of febrile UTI (OR 17.3, 95% CI 3.51–85.26, p < 0.001).
Conclusion
The development of UTI in newborn males with ARM is associated with the presence of VUR, regardless of stoma type. Voiding cystourethrography should be considered in patients with ARM for early diagnosis of VUR and subsequent antibiotic prophylaxis.
Similar content being viewed by others
References
Peters CA, Skoog SJ, Arant BS Jr, Copp HL, Elder JS, Hudson RG, Khoury AE, Lorenzo AJ, Pohl HG, Shapiro E, Snodgrass WT, Diaz M (2010) Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol 184:1134–1144
Metts JC 3rd, Kotkin L, Kasper S, Shyr Y, Adams MC, Brock JW 3rd (1997) Genital malformations and coexistent urinary tract or spinal anomalies in patients with imperforate anus. J Urol 158:1298–1300
McLorie GA, Sheldon CA, Fleisher M, Churchill BM (1987) The genitourinary system in patients with imperforate anus. J Pediatr Surg 22:1100–1104
Liechty ST, Barnhart DC, Huber JT, Zobell S, Rollins MD (2016) The morbidity of a divided stoma compared to a loop colostomy in patients with anorectal malformation. J Pediatr Surg 51:107–110
Pena A, Migotto-Krieger M, Levitt MA (2006) Colostomy in anorectal malformations: a procedure with serious but preventable complications. J Pediatr Surg 41:748–756 (discussion 748–756)
van den Hondel D, Sloots C, Meeussen C, Wijnen R (2014) To split or not to split: colostomy complications for anorectal malformations or hirschsprung disease: a single center experience and a systematic review of the literature. Eur J Pediatr Surg 24:61–69
Youssef F, Arbash G, Puligandla PS, Baird RJ (2017) Loop versus divided colostomy for the management of anorectal malformations: a systematic review and meta-analysis. J Pediatr Surg 52:783–790
Oda O, Davies D, Colapinto K, Gerstle JT (2014) Loop versus divided colostomy for the management of anorectal malformations. J Pediatr Surg 49:87–90 (discussion 90)
Mullassery D, Iacona R, Cross K, Blackburn S, Kiely E, Eaton S, Curry J, De Coppi P (2018) Loop colostomies are safe in anorectal malformations. J Pediatr Surg 53:2170–2173
Georgeson KE, Inge TH, Albanese CT (2000) Laparoscopically assisted anorectal pull-through for high imperforate anus—a new technique. J Pediatr Surg 35:927–930 (discussion 930–921)
Li S, Liu Y, Chang X et al (2019) Two-staged versus three-staged laparoscopic anorectoplasty for patients with rectoprostatic and bladder neck fistulas: a comparative study. J Laparoendosc Adv Surg Tech A 29(11):1486–1491
Jung SM, Lee SK, Seo JM (2013) Experience with laparoscopic-assisted anorectal pull-through in 25 males with anorectal malformation and rectourethral or rectovesical fistulae: postoperative complications and functional results. J Pediatr Surg 48:591–596
Orellana P, Baquedano P, Rangarajan V, Zhao JH, Eng ND, Fettich J, Chaiwatanarat T, Sonmezoglu K, Kumar D, Park YH, Samuel AM, Sixt R, Bhatnagar V, Padhy AK (2004) Relationship between acute pyelonephritis, renal scarring, and vesicoureteral reflux. Results of a coordinated research project. Pediatr Nephrol 19:1122–1126
Williams G, Hodson EM, Craig JC (2019) Interventions for primary vesicoureteric reflux. Cochrane Database Syst Rev 2:CD001532
de Blaauw I, Wijers CH, Schmiedeke E, Holland-Cunz S, Gamba P, Marcelis CL, Reutter H, Aminoff D, Schipper M, Schwarzer N, Grasshoff-Derr S, Midrio P, Jenetzky E, van Rooij IA (2013) First results of a European multi-center registry of patients with anorectal malformations. J Pediatr Surg 48:2530–2535
Sanchez S, Ricca R, Joyner B, Waldhausen JH (2014) Vesicoureteral reflux and febrile urinary tract infections in anorectal malformations: a retrospective review. J Pediatr Surg 49:91–94 (discussion 94)
Pena A, Devries PA (1982) Posterior sagittal anorectoplasty: important technical considerations and new applications. J Pediatr Surg 17:796–811
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors have no conflicts of interest to disclose.
Ethical approval
Ethical approval was waived by the Institutional Review Board at Samsung Medical Center in view of the retrospective nature of the study (IRB no. 2020-03-106).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kim, W., Lee, S. & Seo, JM. Vesicoureteral reflux increases the risk of urinary tract infection prior to corrective surgery in newborn males with anorectal malformation. Pediatr Surg Int 36, 1495–1500 (2020). https://doi.org/10.1007/s00383-020-04761-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-020-04761-6