Epididymitis in Infants with Anorectal Malformation
Introduction
Epididymitis is one of the causes of acute scrotum in children. Its differential diagnosis should be made immediately, since some other causes of acute scrotum require emergency surgical exploration [1]. Epididymitis is an inflammatory reaction of epididymis to a variety of infectious agents, trauma or sterile urine. Reflux of the urine from the urethra into the ejaculatory duct has also been shown to be a cause of epididymitis [2], [3], [4]. An underlying urogenital anomaly might be present in cases of epididymitis, particularly if the patient is an infant or prepubertal boy [5], [6], [7].
Anorectal malformation (ARM) is a troublesome congenital anomaly in children with its long-term complications and associated anomalies [8], [9]. Among the various associated urogenital pathologies, epididymitis is a rare one [5], [6], [10], [11], [12], [13], [14], [15].
We reviewed our patients with ARM and documented the characteristics of epididymitis, which occurred in these patients.
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Materials and methods
One hundred sixteen consecutive patients (66 male, 50 female) were operated for ARM during the period between January 1990 and January 2000, in Marmara University Hospital, Istanbul, Turkey. All of these patients had their definitive operations in our institution. We reviewed 58 of these 66 boys with a mean follow-up period of 7.8 years (2–12 years). Patients with intermediate and high type ARM were managed with posterior sagittal anorectoplasty (PSARP) and patients with low type ARM were
Results
Four patients, who had epididymitis underwent their corrective PSARP operation at 17, 9, 6 and 13 months of age and they were followed up for 9, 9, 7 and 7 years, respectively. The first patient required repeated urethral dilatations and had several urinary tract infections after the urethral repair. He had also some bladder dysfunction symptoms after cystostomy and antireflux procedure, but he did not have a recurrence of epididymitis after PSARP and cystostomy. His testicles were normal in
Discussion
Epididymitis is a relatively rare pathology in childhood. Its differentiation from other acute scrotal pathologies is important, since some of them require emergency operation [1]. In many series, an underlying genitourinary abnormality were found in most of the infants and prepubertal boys with epididymitis [5], [6], [7]. UEDR has also been implicated in the aetiology of epididymitis in children [2], [3], [4], [5], [6]. Reflux of urine, whether infected or sterile, from the urethra into the
References (15)
- et al.
Reflux of urine into ejaculatory ducts as a cause of recurring epididymitis in children
J. Urol.
(1972) - et al.
Idiopathic urethro-ejaculatory reflux
J. Urol.
(1977) - et al.
Urinary reflux via the vas deferens: Unusual cause of epididymitis in infancy
J. Pediatr.
(1972) - et al.
Epididymitis in infants and boys: Underlying urogenital anomalies and efficacy of imaging modalities
J. Urol.
(1987) Urologic implications of anorectal malformations
Urol. Clin. North Am.
(1985)- et al.
Epididymitis in infancy
J. Urol.
(1979) - et al.
Acute scrotum due to edidymo-orchitis associated with vasal anomalies in children with anorectal malformations
J. Pediatr. Surg.
(1998)