High-grade Vesicoureteral Reflux in Patients With Anorectal Malformation From the ARM-Net Registry: Is Our Screening Sufficient?

Autor: van der Steeg HJJ; Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands. Electronic address: herjan.vandersteeg@radboudumc.nl., Luijten JCHBM; Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands., Fascetti-Leon F; Department of Pediatric Surgery, University of Padua, Padua, Italy., Miserez M; Department of Abdominal Surgery, UZ Leuven, KU Leuven, Belgium., Samuk I; Department of Pediatric Surgery, Schneider Children's Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Stenström P; Department of Pediatrics, Clinical Sciences Lund University, Skane University Hospital Lund, Sweden., de Wall LL; Department of Urology, Division of Pediatric Urology, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands., de Blaauw I; Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands., van Rooij IALM; Department for Health Evidence, Radboud University Medical Center Nijmegen, the Netherlands.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2024 Aug; Vol. 59 (8), pp. 1470-1476. Date of Electronic Publication: 2024 Jan 19.
DOI: 10.1016/j.jpedsurg.2024.01.008
Abstrakt: Background: Vesico-ureteral reflux (VUR) is a common associated urological anomaly in anorectal malformation (ARM)-patients. High-grade VUR requires antibiotic prophylaxis to prevent urinary tract infections (UTI's), renal scarring and -failure. The exact prevalence of high-grade VUR in ARM patients is unknown. Hence, the aim of this study was determining the incidence of high-grade VUR in ARM-patients, and its associated risk factors.
Methods: A multicenter retrospective cohort study was performed using the ARM-Net registry, including data from 34 centers. Patient characteristics, screening for and presence of renal anomalies and VUR, sacral and spinal anomalies, and sacral ratio were registered. Phenotypes of ARM were grouped according to their complexity in complex and less complex. Multivariable analyses were performed to detect independent risk factors for high-grade (grade III-V) VUR.
Results: This study included 2502 patients (50 % female). Renal screening was performed in 2250 patients (90 %), of whom 648 (29 %) had a renal anomaly documented. VUR-screening was performed in 789 patients (32 %), establishing high-grade VUR in 150 (19 %). In patients with a normal renal screening, high-grade VUR was still present in 10 % of patients. Independent risk factors for presence of high-grade VUR were a complex ARM (OR 2.6, 95 %CI 1.6-4.3), and any renal anomaly (OR 3.3, 95 %CI 2.1-5.3).
Conclusions: Although renal screening is performed in the vast majority of patients, only 32 % underwent VUR-screening. Complex ARM and any renal anomaly were independent risk factors for high-grade VUR. Remarkably, 10 % had high-grade VUR despite normal renal screening. Therefore, VUR-screening seems indicated in all ARM patients regardless of renal screening results, to prevent sequelae such as UTI's, renal scarring and ultimately renal failure.
Type of Study: Observational Cohort-Study.
Level of Evidence: III.
Competing Interests: Conflict of interest None.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: