Tohda A, Hosokawa S, Shimada K
Division of Urology, Osaka Medical Center.
Nihon Hinyokika Gakkai Zasshi. 1995 Aug;86(8):1388-93. doi: 10.5980/jpnjurol1989.86.1388.
Anorectal malformation (ARM) is often associated with urological problems such as congenital urogenital anomalies, recto-urinary fistula, neurogenic bladder due to vertebral anomalies and operative complications. We analyzed 57 cases of ARM and discussed about the management of associated urogenital anomalies during neonatal and infantile period. The incidence of urogenital anomalies was 85.7% in high type, 65.5% in intermediate type and 38.1% in low type. Among these urinary tract anomalies, VUR was most common and was documented in 38.6% of ARM patients. Renal dysplasia, PUJ stenosis, megaureter and urethral stenosis was also common in these patients. Renal dysfunction was documented in 5 cases (2 in high type, 2 in intermediate and 1 in low type), mainly due to VUR and renal aplasia. These results show the need for evaluation of urinary tract during the neonatal and early infantile period even in low type ARM. The management of urinary tract anomalies associated with ARM is firmly related with the management of ARM itself, and we must be closely in co-operation with pediatric surgeons.
肛门直肠畸形(ARM)常伴有泌尿系统问题,如先天性泌尿生殖系统异常、直肠尿道瘘、因脊柱异常导致的神经源性膀胱及手术并发症。我们分析了57例ARM病例,并探讨了新生儿及婴儿期相关泌尿生殖系统异常的处理方法。泌尿生殖系统异常的发生率在高位型为85.7%,中位型为65.5%,低位型为38.1%。在这些泌尿系统异常中,膀胱输尿管反流(VUR)最为常见,在38.6%的ARM患者中被记录到。肾发育不良、肾盂输尿管连接处狭窄、巨输尿管和尿道狭窄在这些患者中也很常见。5例(高位型2例、中位型2例、低位型1例)出现肾功能障碍,主要原因是VUR和肾发育不全。这些结果表明,即使是低位型ARM,在新生儿及婴儿早期也需要对泌尿系统进行评估。与ARM相关的泌尿系统异常的处理与ARM本身的处理密切相关,我们必须与小儿外科医生密切合作。