ABSTRACT
Introduction 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. Materials and 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. Conclusion 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 .
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Humans , Infant , Male , Young Adult , Anus, Imperforate/complications , Epididymitis/etiology , Urologic Diseases/etiology , Anus, Imperforate/physiopathology , Anus, Imperforate/surgery , Cystoscopy , Epididymitis/physiopathology , Epididymitis/surgery , Recurrence , Retrospective Studies , Urodynamics , Urinary Bladder Fistula/physiopathology , Urinary Bladder, Neurogenic/etiology , Urinary Bladder, Neurogenic/physiopathology , Urinary Bladder, Neurogenic/surgery , Urinary Bladder/physiopathology , Urologic Diseases/physiopathology , Urologic Diseases/surgeryABSTRACT
Entre los años 1989 y 1994 fueron tratados quirúrgicamente 147 pacientes con Síndrome Escrotal Agudo (SEA). La torsión de Hidátide de Morgagni fue la condición mas frecuente (75 por ciento), la torsión testicular ocurrió en 44 pacientes (30 por ciento) y el resto correspondieron a orquiepidimitis. El rango de edad fue de 2 días a 15 años. De los niños que sufrieron torsión testicular, 32 (73 por ciento) conservaron su gónada y en 12 de ellos fue necesaria la orquectomía. La orquidopexia contralateral se realizó en todos los casos. El diagnóstico clínico y la exploración escrotal precoz permiten la preservación testicular, en la mayoría de los pacientes con torsión testicular