Vesicoureteral reflux and febrile urinary tract infections in anorectal malformations: A retrospective review

• Published in: Journal of pediatric surgery Vol. 49; no. 1; pp. 91 - 94
• Main Authors: Sanchez, Sabrina, Ricca, Robert, Joyner, Byron, Waldhausen, John H.T
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2014
• Subjects: Abnormalities, Multiple - epidemiology; Abnormalities, Multiple - surgery; Anal Canal - abnormalities; Anal Canal - surgery; Anorectal malformation; Anorectal Malformations; Antibiotic Prophylaxis; Anus, Imperforate - complications; Anus, Imperforate - surgery; Comorbidity; Disease Susceptibility; Female; Fever - etiology; Heart Defects, Congenital - epidemiology; Heart Defects, Congenital - surgery; Humans; Infant; Infant, Newborn; Kidney - abnormalities; Male; Neural Tube Defects - epidemiology; Pediatrics; Rectal Fistula - epidemiology; Rectum - abnormalities; Rectum - surgery; Retrospective Studies; Surgery; Urethral Diseases - epidemiology; Urinary Bladder Fistula - epidemiology; Urinary Fistula - epidemiology; Urinary tract infection; Urinary Tract Infections - etiology; Urinary Tract Infections - prevention & control; Urogenital Abnormalities - complications; Urogenital Abnormalities - epidemiology; Urogenital Abnormalities - surgery; Vesico-Ureteral Reflux - etiology; Vesico-Ureteral Reflux - surgery; Vesicoureteral reflux; Voiding cystourethrogram; Voiding cystourethrogram; Urinary tract infection; Vesicoureteral reflux; Anorectal malformation
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2013.09.031

Abstract Background Multiple studies document a correlation between anorectal malformations (ARMs) and vesicoureteral reflux (VUR), development of urinary tract infections (UTIs), and subsequent renal disease. We aimed to determine which patient characteristics are associated with VUR and UTI in this population. Methods A retrospective review of ARM patients at a free-standing children’s hospital from January 1996 to December 2011 was performed. Logistic regression was used to investigate the associations between VUR and UTI and ARM classification and co-morbid diagnoses. Results Of 190 patients, 41 (31%) received a diagnosis of VUR. Thirty-one of the 190 patients had at least one febrile UTI (16%). Of these, only 16 (51%) had a diagnosis of VUR. On multivariable logistic regression, the only patient variable associated with VUR was having an ectopic kidney (p = 0.026). Similarly, the presence of GU malformations was the closest variable associated with developing a UTI (p = 0.073). Conclusions In ARM patients, VUR as well as UTIs are associated with the presence of GU malformations. Thus, voiding cystourethrogram (VCUG) testing should be pursued when there are other caudal and GU abnormalities, regardless of fistula location. Antibiotic prophylaxis for UTI should be considered in children with ARM and any GU malformation, not only VUR.