title: Epididymo-orchitis complicating anorectal malformations: collective review of 41 cases.
abstract: OBJECTIVE
  Epididymo-orchitis is a devastating complication of imperforate anus. Without proper treatment the condition may result in infertility. Nevertheless, the exact etiology and optimal management of epididymo-orchitis in anorectal malformation are unknown.
  
  
  METHODS
  Retrospective review of our hospital records between 1997 and 2010 identified 6 cases of epididymo-orchitis in 82 boys with anorectal malformation. Extensive search of the literature revealed 35 additional cases. Clinical details of these 41 patients were analyzed using chi-square testing.
  
  
  RESULTS
  Epididymo-orchitis occurred predominantly (86%) in high or intermediate anorectal malformation with rectourinary fistula. Median age at onset of epididymo-orchitis was 6 months and there was no side predilection. Urinary tract infection was noted in 54% of patients. Persistent mesonephric duct syndrome (27%), urethroejaculatory duct reflux (22%), vasovesical ectopia (10%), neurovesical dysfunction (34%) and urethral stricture/stenosis (17%) were frequently associated risk factors for epididymo-orchitis. In 73% of patients epididymo-orchitis recurred with exclusive antibiotic treatment. Diverting colostomy was ineffective in preventing epididymo-orchitis. Division of rectourinary fistula was curative in 36% of patients, while in 34% epididymo-orchitis recurred even after division of rectourinary fistula. Division of rectourinary fistula is likely to resolve epididymo-orchitis in the absence of additional risk factors. Vasectomy was required in 22% of patients to prevent recurrence.
  
  
  CONCLUSIONS
  In addition to rectourinary fistula, urinary reflux into the vas deferens and neurovesical dysfunction are major risk factors for epididymo-orchitis in anorectal malformation. Division of rectourinary fistula is curative in only a third of cases. In the remaining cases some form of surgical disruption of the vas deferens is needed to resolve recurrent epididymo-orchitis.
authors.affiliation: Division of Pediatric Surgery, Rajah Muthiah Medical College, Annamalai University, Tamilnadu, India. vrthiran@yahoo.co.in
authors.forename: Venkatachalam
authors.initials: V
authors.lastname: Raveenthiran
authors.forename: Cenita J
authors.initials: CJ
authors.lastname: Sam
mesh_terms: D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000150:complications*; D004823:Epididymitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009920:Orchitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012003:Rectal Fistula / Q000150:complications; D012307:Risk Factors; D001747:Urinary Bladder Fistula / Q000150:complications; D014649:Vas Deferens / Q000002:abnormalities; D014928:Wolffian Ducts / Q000002:abnormalities