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

van der Steeg, H. J.J. ; Luijten, J. C.H.B.M. ; Fascetti-Leon, F. ; Miserez, M. ; Samuk, I. ; Stenström, P. LU orcid ; de Wall, L. L. ; de Blaauw, I. and van Rooij, I. A.L.M. (2024) In Journal of Pediatric Surgery
Abstract

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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Anorectal malformation, ARM-Net, High-grade VUR, Renal screening, Risk factors, VCUG, Vesicoureteral reflux
in
Journal of Pediatric Surgery
publisher
Elsevier
external identifiers
  • pmid:38355337
  • scopus:85187264729
ISSN
0022-3468
DOI
10.1016/j.jpedsurg.2024.01.008
language
English
LU publication?
yes
id
89ca4d12-f564-4878-a3ff-5118f0b31303
date added to LUP
2024-04-03 15:01:08
date last changed
2024-04-17 17:11:02
@article{89ca4d12-f564-4878-a3ff-5118f0b31303,
  abstract     = {{<p>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.</p>}},
  author       = {{van der Steeg, H. J.J. and Luijten, J. C.H.B.M. and Fascetti-Leon, F. and Miserez, M. and Samuk, I. and Stenström, P. and de Wall, L. L. and de Blaauw, I. and van Rooij, I. A.L.M.}},
  issn         = {{0022-3468}},
  keywords     = {{Anorectal malformation; ARM-Net; High-grade VUR; Renal screening; Risk factors; VCUG; Vesicoureteral reflux}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Pediatric Surgery}},
  title        = {{High-grade Vesicoureteral Reflux in Patients With Anorectal Malformation From the ARM-Net Registry : Is Our Screening Sufficient?}},
  url          = {{http://dx.doi.org/10.1016/j.jpedsurg.2024.01.008}},
  doi          = {{10.1016/j.jpedsurg.2024.01.008}},
  year         = {{2024}},
}