title: Epididymitis in patients with anorectal malformations: a cause for urologic concern.
abstract: BACKGROUND
  Epididymitis in patients with anorectal malformation (ARM) represents a unique problem because unlike the general population, an underlying urinary tract problem is frequently identified. We review our experience with epididymitis in ARM population with an emphasis on examining urologic outcomes.
  
  
  METHODS
  We performed a retrospective review of male patients with ARM cared for from 1980 to 2010. Clinical and pathologic variables recorded included age at presentation, recurrence, associated urologic anomalies, incidence of ureteral fusion with mesonephric ductal structures, glomerular filtration rate and urodynamic parameters.
  
  
  RESULTS
  Twenty-six patients were identified with documented episodes of epididymitis. Renal injury was noted in five patients (19%), all of whom were diagnosed with neurogenic bladder (NGB) several years after anorectoplasty. NGB was found in ten patients (38%) in our series. Ectopic insertion of ureter into a mesonephric ductal structure was discovered in five patients (19%). Twelve patients (46%) had recurrent episodes of epididymitis, with seven of these patients (58%) being diagnosed with NGB. Two patients in the pubertal group presented with a history of epididymitis and complained of ejaculatory pain.
  
  
  CONCLUSIONS
  Epididymitis in a patient with ARM warrants a comprehensive urologic investigation, particularly in recurrent episodes. Attempts at surgical intervention (e.g. vasectomy) should be avoided until functional assessment of the urinary tract has occurred. Failure to recognize this association may lead to potentially avoidable complications and morbidity. Long term urological follow up of these patients is warranted to identify at risk patients and minimize renal deterioration.
authors.affiliation: Division of Urology, Division of Pediatric Surgery at Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: VanderBrink
authors.affiliation: Division of Urology, Division of Pediatric Surgery at Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio USA.
authors.forename: Bezalel
authors.initials: B
authors.lastname: Sivan
authors.affiliation: Division of Urology, Division of Pediatric Surgery at Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Levitt
authors.affiliation: Colorectal Center for Children, Division of Pediatric Surgery at Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio USA.
authors.forename: Alberto
authors.initials: A
authors.lastname: Peña
authors.affiliation: Division of Urology, Division of Pediatric Surgery at Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio USA.
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Sheldon
authors.affiliation: Division of Urology, Division of Pediatric Surgery at Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio USA.
authors.forename: Shumyle
authors.initials: S
authors.lastname: Alam
mesh_terms: D000293:Adolescent; D000328:Adult; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D004823:Epididymitis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000503:physiopathology; D001747:Urinary Bladder Fistula / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D014563:Urodynamics; D014570:Urologic Diseases / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult