Alder Hey Children's Hospital, East Prescot Rd, Liverpool, United Kingdom; University of Liverpool, Brownlow Hill, Liverpool, United Kingdom.
Alder Hey Children's Hospital, East Prescot Rd, Liverpool, United Kingdom.
J Pediatr Surg. 2021 Oct;56(10):1811-1815. doi: 10.1016/j.jpedsurg.2021.02.062. Epub 2021 Mar 5.
Children with anorectal malformations (ARM) have a high rate of renal anomalies and increased risk of urinary tract infection (UTI). We aimed to determine whether using routine Micturating Cystourethrogram (MCUG) to detect VUR is effective in reducing the incidence of UTI or renal scarring in children with ARM.
A retrospective study of consecutive children diagnosed with ARM in two centres with a minimum of 3 years follow-up was performed, excluding those with cloaca or an MCUG prior to ARM repair. Univariate and multivariate logistic regression analysis was used to determine variables which were associated with VUR, UTI and renal scarring. Associations are described as Odd's Ratio (OR), 95% Confidence Interval. Significance was taken as p<0.05.
344 children were included with a median age of 8 years (IQR 5-11 years). 150 (44%) were female. 89 (26%) had renal anomalies and 101 (29%) had spine anomalies. 148 patients had routine MCUG and VUR was found in 62 (42%) of these children. Univariate analysis did not correlate any of the assessed variables with VUR or renal scarring. However, abnormal renal ultrasound - OR 6.18 (95% CI 2.99-13.07, p 0.0001) was associated with UTI whilst abnormal spine - OR 0.27 (95% CI 0.10-0.62, p 0.009), low ARM - OR 0.30 (CI 0.14-0.63, p 0.006) and intermediate ARM - OR 0.35 (CI 0.17-0.70, p 0.01) were associated with a reduced risk of UTI. On multivariate analysis, only abnormal renal USS retained a significant association with UTI (p<0.0001).
VUR is common in patients with ARM. Children with an abnormal R-USS are at increased risk of UTI. Performing routine MCUG does not reduce the risk of UTI in children with ARM.
患有肛门直肠畸形（ARM）的儿童存在高比例的肾脏异常和尿路感染（UTI）风险增加。我们旨在确定在 ARM 患儿中，是否使用常规排尿性膀胱尿道造影术（MCUG）检测反流（VUR）有助于降低 UTI 或肾瘢痕的发生率。
对在两个中心接受 ARM 诊断的连续患儿进行回顾性研究，随访时间至少为 3 年，排除伴有泄殖腔或 ARM 修复前进行 MCUG 的患儿。采用单变量和多变量逻辑回归分析确定与 VUR、UTI 和肾瘢痕相关的变量。关联用比值比（OR）和 95%置信区间（CI）描述。以 p<0.05 为有统计学意义。
共纳入 344 例患儿，中位年龄为 8 岁（IQR 5-11 岁）。150 例（44%）为女性。89 例（26%）存在肾脏异常，101 例（29%）存在脊柱异常。148 例行常规 MCUG，其中 62 例（42%）发现 VUR。单变量分析未发现任何评估变量与 VUR 或肾瘢痕相关。然而，异常肾脏超声 - OR 6.18（95%CI 2.99-13.07，p<0.0001）与 UTI 相关，而异常脊柱 - OR 0.27（95%CI 0.10-0.62，p=0.009）、低位 ARM - OR 0.30（CI 0.14-0.63，p=0.006）和中间位 ARM - OR 0.35（CI 0.17-0.70，p=0.01）与 UTI 风险降低相关。多变量分析中，仅异常肾脏 USS 与 UTI 存在显著关联（p<0.0001）。
VUR 在 ARM 患儿中较为常见。存在异常 R-USS 的患儿 UTI 风险增加。在 ARM 患儿中常规行 MCUG 并不能降低 UTI 的风险。
