Seattle Children's Hospital University of Washington School of Medicine.
Seattle Children's Hospital University of Washington School of Medicine.
J Pediatr Surg. 2014 Jan;49(1):91-4; discussion 94. doi: 10.1016/j.jpedsurg.2013.09.031. Epub 2013 Oct 5.
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.
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.
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).
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.
多项研究证明，肛门直肠畸形（ARM）与上尿路反流（VUR）、尿路感染（UTI）的发展以及随后的肾脏疾病之间存在相关性。我们旨在确定哪些患者特征与该人群中的 VUR 和 UTI 相关。
对一家独立儿童医院 1996 年 1 月至 2011 年 12 月间 ARM 患者进行回顾性研究。采用逻辑回归分析 ARM 分类和合并诊断与 VUR 和 UTI 之间的相关性。
190 例患者中，41 例（31%）诊断为 VUR。190 例患者中有 31 例（16%）至少发生过一次发热性 UTI。其中，仅有 16 例（51%）诊断为 VUR。多变量逻辑回归分析显示，唯一与 VUR 相关的患者变量是存在异位肾（p=0.026）。同样，GU 畸形的存在与发生 UTI 最密切相关（p=0.073）。
在 ARM 患者中，VUR 和 UTI 与 GU 畸形的存在有关。因此，无论瘘管位置如何，当存在尾部和 GU 其他异常时，应进行排尿性膀胱尿道造影（VCUG）检查。对于 ARM 患者和任何 GU 畸形患者，应考虑预防性使用抗生素治疗 UTI，而不仅仅是 VUR。
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