Urethro-ejaculatory duct reflux in children: an updated review

Reflux of urine into the ejaculatory ducts of children may result in recurrent orchitis and sterility. Urethro-ejaculatory duct reflux (UER) is an uncommonly reported condition in children. The diagnosis of this condition can be made using a micturating cystourethrogram (MCUG) to demonstrate the reflux of contrast into any of the ejaculatory ducts. The aim of this study was to look at the incidence of UER in the broader pediatric population and review the management options.

A retrospective study was made of all MCUGs done in boys up to 13 years of age in all service departments caring for children in a teaching hospital. Those studies demonstrating UER were correlated with the hospital and departmental clinical notes.

Over a 6 1/2 year period, 360 MCUGs were done in boys, and UER was demonstrated in 54 boys treated in seven departments. Twenty-three patients had recognized causes of UER. Eighteen patients were found to have other urological pathologies, and seven patients had neurological or complex VACTERL pathologies. The remaining six patients had no underlying pathology but presented with orchitis or torsion. Reflux into the seminal vesicles was the most frequent finding (74%), but reflux into the ductus deferens was the most debilitating. Orchitis was seen in a total of nine patients, and biopsies showed severe destruction of testicular tissue in these patients. Management of patients with recognized UER consisted of attempted correction of the underlying pathology and prolonged antibiotics. Where this failed in 6 patients, vasectomy was done in 4, and injection of a bulking gel into the verumontanum was done in 2 patients to prevent ongoing orchitis and pain.

UER is more common then originally thought. All boys who present with uro-genital symptoms should have a MCUG as part of the investigative work-up and be scrutinized for UER. Management should aim at correcting any underlying anomaly and providing prolonged antibiotics, but vasectomy and the injection of a bulking agent should be considered. The indications for these newer forms of treatment are not clearly defined.