Simultaneous diagnosis of vesico ureteral reflux and recto-urinary tract fistula in boys with anorectal malformation : Methodology and outcome
Börjesson, Anna LU ; Hambraeus, Mette LU ; Götestrand, Simon LU ; Wiklund, Marie ; Tofft, Louise LU
and Stenström, Pernilla
LU
(2025)
In Journal of Pediatric Surgery Open
12.
- Abstract
Introduction: Most centers treating patients with anorectal malformation (ARM) will screen for anomalies of the kidneys and urinary tract by using ultrasonography. There is no consensus on whether screening for vesico-ureteral reflux (VUR) should occur. To meet the diagnostic needs of ARM patients a method was developed to include a simultaneous VUR diagnosis and pre-reconstructive fistula work-up in a combined voiding urethral cystogram (VCUG), colostogram, and retrograde urethrogram (RUG) examination. Material and methods: The study was undertaken for male ARM patients diagnosed and operated on between 1st of January 2013 to 31st of December 2023 at a national specialized medical center for ARM covering 4.5 million residents. Since... (More)
Introduction: Most centers treating patients with anorectal malformation (ARM) will screen for anomalies of the kidneys and urinary tract by using ultrasonography. There is no consensus on whether screening for vesico-ureteral reflux (VUR) should occur. To meet the diagnostic needs of ARM patients a method was developed to include a simultaneous VUR diagnosis and pre-reconstructive fistula work-up in a combined voiding urethral cystogram (VCUG), colostogram, and retrograde urethrogram (RUG) examination. Material and methods: The study was undertaken for male ARM patients diagnosed and operated on between 1st of January 2013 to 31st of December 2023 at a national specialized medical center for ARM covering 4.5 million residents. Since 2013, all patients with ARM have been prospectively registered in a local ARM-register. Inclusion criteria were male ARM-patients without perineal fistula, who had pre-reconstruction work up and reconstructive surgery for ARM performed at the center. For VUR and recto-urethral fistula diagnosis, the imaging procedure consisted of three consecutive parts: VCUG, high pressure colostogram and, if needed for correct fistula imaging a RUG. Results: During the period, 37 male patients with ARM and recto-urethral- or no fistula were treated at the center. Eleven patients were excluded leaving 26 patients eligible for inclusion. 18 patients (69 %) had no VUR, 4 (15 %) had VUR grade 3–5. Eleven of 26 patients, (42 %), presented clinical signs of a having an open recto-ur fistula. For visualization of fistula presence and level, 3 patients (12 %) had a VCUG only, 13 (50 %) VCUG and colostogram, and in 10 patients (38 %) a retrograde urethrogram was added. During reconstruction, no fistula was identified in four patients (15 %) while three (12 %) had recto-bulbar fistula, 14 (54 %) recto-prostatic fistula and five (19 %) recto-bladder neck fistula. Discussion: We present a method for a simultaneous diagnosis of VUR and ARM-subtype during pre-reconstructive work-up in patients with complex ARM. The incidence of VUR grade 3 or higher was 15 %, with poor correlation between high grade VUR and dilatation of the upper urinary tract identified on ultrasound. The accuracy of open fistula presence was 25/26 (96 %) while the accuracy for the anatomic display of fistula level varied from 80 % in recto-bladder neck fistula, to 93 % in recto-prostatic-, and 100 % in recto-bulbar fistula. Conclusion: We found the method of a simultaneous diagnosis of VUR and recto-urinary tract fistula was a good option with low risks for preoperative evaluation in male patients with complex ARM.
(Less)
- author
- Börjesson, Anna
LU
; Hambraeus, Mette
LU
; Götestrand, Simon
LU
; Wiklund, Marie
; Tofft, Louise
LU
and Stenström, Pernilla
LU
- organization
- publishing date
- 2025-11
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Anorectal malformation, Diagnosis, Male patients, Recto-urinary tract fistula, VCUG, Vesico-ureteral reflux
- in
- Journal of Pediatric Surgery Open
- volume
- 12
- article number
- 100224
- publisher
- Elsevier
- external identifiers
-
- scopus:105024340453
- ISSN
- 2949-7116
- DOI
- 10.1016/j.yjpso.2025.100224
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2025
- id
- f88b88f1-3d44-47c2-b651-bba96c56e986
- date added to LUP
- 2026-02-19 13:40:04
- date last changed
- 2026-02-20 09:15:13
@article{f88b88f1-3d44-47c2-b651-bba96c56e986,
abstract = {{<p>Introduction: Most centers treating patients with anorectal malformation (ARM) will screen for anomalies of the kidneys and urinary tract by using ultrasonography. There is no consensus on whether screening for vesico-ureteral reflux (VUR) should occur. To meet the diagnostic needs of ARM patients a method was developed to include a simultaneous VUR diagnosis and pre-reconstructive fistula work-up in a combined voiding urethral cystogram (VCUG), colostogram, and retrograde urethrogram (RUG) examination. Material and methods: The study was undertaken for male ARM patients diagnosed and operated on between 1st of January 2013 to 31st of December 2023 at a national specialized medical center for ARM covering 4.5 million residents. Since 2013, all patients with ARM have been prospectively registered in a local ARM-register. Inclusion criteria were male ARM-patients without perineal fistula, who had pre-reconstruction work up and reconstructive surgery for ARM performed at the center. For VUR and recto-urethral fistula diagnosis, the imaging procedure consisted of three consecutive parts: VCUG, high pressure colostogram and, if needed for correct fistula imaging a RUG. Results: During the period, 37 male patients with ARM and recto-urethral- or no fistula were treated at the center. Eleven patients were excluded leaving 26 patients eligible for inclusion. 18 patients (69 %) had no VUR, 4 (15 %) had VUR grade 3–5. Eleven of 26 patients, (42 %), presented clinical signs of a having an open recto-ur fistula. For visualization of fistula presence and level, 3 patients (12 %) had a VCUG only, 13 (50 %) VCUG and colostogram, and in 10 patients (38 %) a retrograde urethrogram was added. During reconstruction, no fistula was identified in four patients (15 %) while three (12 %) had recto-bulbar fistula, 14 (54 %) recto-prostatic fistula and five (19 %) recto-bladder neck fistula. Discussion: We present a method for a simultaneous diagnosis of VUR and ARM-subtype during pre-reconstructive work-up in patients with complex ARM. The incidence of VUR grade 3 or higher was 15 %, with poor correlation between high grade VUR and dilatation of the upper urinary tract identified on ultrasound. The accuracy of open fistula presence was 25/26 (96 %) while the accuracy for the anatomic display of fistula level varied from 80 % in recto-bladder neck fistula, to 93 % in recto-prostatic-, and 100 % in recto-bulbar fistula. Conclusion: We found the method of a simultaneous diagnosis of VUR and recto-urinary tract fistula was a good option with low risks for preoperative evaluation in male patients with complex ARM.</p>}},
author = {{Börjesson, Anna and Hambraeus, Mette and Götestrand, Simon and Wiklund, Marie and Tofft, Louise and Stenström, Pernilla}},
issn = {{2949-7116}},
keywords = {{Anorectal malformation; Diagnosis; Male patients; Recto-urinary tract fistula; VCUG; Vesico-ureteral reflux}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{Journal of Pediatric Surgery Open}},
title = {{Simultaneous diagnosis of vesico ureteral reflux and recto-urinary tract fistula in boys with anorectal malformation : Methodology and outcome}},
url = {{http://dx.doi.org/10.1016/j.yjpso.2025.100224}},
doi = {{10.1016/j.yjpso.2025.100224}},
volume = {{12}},
year = {{2025}},
}