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Published on: October 12, 2017
Vesicoureteral reflux in children with urachal anomalies
Janelle A Fox1, Shawn M McGee, Jonathan C Routh
1Department of Urology, Mayo Clinic, Rochester, MN 55905, USA. fox.janelle@mayo.edu
Insights
This study found a high incidence of vesicoureteral reflux (VUR) in children with urachal anomalies (UA). Further research is needed to confirm this association and guide clinical evaluation.
Area of Science:
- Pediatric Urology
- Congenital Anomalies
- Genitourinary Tract Development
Background:
- Urachal anomalies (UA) are congenital conditions affecting the urachus, a remnant of the allantois.
- Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder to the ureters.
- The association between UA and VUR is not well-established.
Purpose of the Study:
- To report the largest series of VUR in children with UA.
- To investigate the incidence and characteristics of VUR in patients with UA.
- To highlight the importance of evaluating for VUR in children with UA.
Main Methods:
- Retrospective review of medical records from two institutions (1951-2007).
- Inclusion criteria: children diagnosed with UA.
- Data collected on VUR diagnosis, UA type, and management.
Main Results:
- Sixty-nine children with UA were identified (34 cysts, 14 patent, 10 diverticula, 7 sinuses).
- VUR was diagnosed in 64% of children who underwent voiding cystourethrogram (14 out of 22).
- VUR rates were similar across different UA types; no significant age difference was noted between VUR and non-VUR groups.
Conclusions:
- This is the first reported series linking VUR with UA.
- The high incidence of VUR in this cohort suggests a potential correlation requiring prospective investigation.
- Thorough genitourinary and family history are crucial for detecting VUR in children with UA.
Objective:
We report the largest known series of vesicoureteral reflux (VUR) in children with urachal anomalies (UA).
Methods:
Two institutions' records were reviewed for children with UA (1951‒2007).
Results:
Of 30 girls and 36 boys with UA (34 urachal cysts, 14 patent urachus, 10 urachal diverticula, 7 urachal sinuses, and 1 unknown), 57 (86%) underwent surgical resection or drainage. A voiding cystourethrogram was obtained in 22 (33%). VUR was demonstrated in 14 of the 22 children (64%), and rates were similar among the various types of UA. The median age with versus without VUR was not different (1.3 vs 1.7 years, P=0.97). Of 24 refluxing renal units, classification was grade≤3 in 71%, 4‒5 in 12%, and unspecified in 17%. Four children (26%) underwent ureteroneocystostomy and 10 observed patients resolved spontaneously.
Conclusion:
To our knowledge, this is the first series of VUR associated with UA. The increased incidence of VUR (64%) in this small subset of patients warrants prospective studies to determine if there is a positive correlation with UA. We believe thorough genitourinary and family histories are important when evaluating children with UA to help detect clinically significant VUR.
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