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

Infographic · Jan 2023 · 1 min read

In brief

This ARM-Net Consortium study of 29 patients found that 90% of epididymo-orchitis cases in anorectal malformation patients occurred in those with rectourinary fistulas, with 69% experiencing recurrent infections. The high rate of associated urological anomalies and positive urine cultures supports routine urologic evaluation and multidisciplinary management in this population.

90% of ARM patients with epididymo-orchitis had rectourinary fistulas; median age at first episode was 2 years
69% experienced recurrent epididymo-orchitis with 60% ipsilateral recurrence; 69% had positive urine cultures during episodes
Associated urological anomalies common: vesicoureteral reflux (48%), urethral anomalies (41%), neurogenic bladder (41%)
Most cases managed with antibiotics (90%); surgical intervention reserved for 14%; prevention includes bulking agents or prophylaxis
Comprehensive urologic work-up essential for ARM patients to identify and treat underlying risk factors for epididymo-orchitis

Written by the GCMD Library team from the infographic.

A circular diagram with five wedge-shaped sections in navy and light blue radiating from a central dark blue circle labeled 'IDENTIFY RISK FACTORS'. Each wedge contains icons and text representing different clinical aspects. The left side shows urological and spinal anomalies with anatomical illustrations, while the right side displays urinary outcomes and practical algorithms with medical icons. A clock icon indicates timing considerations at the bottom.

Anna Morandi, Maria Fanjul, Barbara Daniela Iacobelli, Inbal Samuk, Dalia Aminoff, Paola Midrio, Ivo de Blaauw, Eberhard Schmiedeke, Alessio Pini Prato, Wout Feitz, Hendrik J J van der Steeg, Dario Guido Minoli, Cornelius E J Sloots, Francesco Fascetti-Leon, Igor Makedonsky, Araceli Garcia, Pernilla Stenström

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.

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