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Urinary tract anomalies and urinary tract dysfunction in children with Hirschsprung disease-Is follow-up indicated?
Christina Granéli1, Hedda Marschall Sima1, Anna Börjesson1
1Department of Pediatric surgery, Skane University Hospital Lund, Institution of Clinical Sciences, Department of Pediatrics, 221 85 Lund, Sweden.
Insights
Children with Hirschsprung disease (HD) have higher rates of urinary tract anomalies and dysfunction, including enuresis and infections. Screening for these issues is recommended during follow-up care for HD patients.
Area of Science:
- Pediatric Surgery
- Urology
- Gastroenterology
Background:
- Urinary tract function is often overlooked in children with Hirschsprung disease (HD).
- Understanding the prevalence of urinary tract anomalies and dysfunction in HD patients is crucial for comprehensive care.
Purpose of the Study:
- To evaluate the prevalence of urinary tract anomalies and dysfunction in children with HD.
- To compare these findings with a control group of healthy children.
Main Methods:
- An observational, cross-sectional, case-control study was conducted.
- Children with HD who underwent transanal endorectal pull-through technique (TERPT) were assessed postoperatively via ultrasound.
- Urinary tract function was evaluated using a questionnaire for children over 4 years old, compared to age-matched healthy controls.
Main Results:
- Ten urinary tract anomalies were diagnosed in 6% of HD children, including structural issues like abnormal kidney size and acquired conditions such as hydronephrosis.
- Children with HD reported significantly higher frequencies of enuresis (65% in boys, 60% in girls) and urinary tract infections (18% in boys) compared to controls.
- Constipation in children with HD was associated with a higher frequency of enuresis.
Conclusions:
- Urinary tract anomalies and dysfunction are significant concerns in the follow-up of children with HD.
- Routine screening for urinary tract anomalies and symptoms is recommended for children diagnosed with HD.
Background/Purpose:
Urinary tract function in children with Hirschsprung disease (HD) is rarely considered.
Aim:
to evaluate the prevalence of urinary tract anomalies and dysfunction in children with HD compared to controls.
Methods:
This was an observational cross sectional case-control study. Children with HD who underwent transanal endorectal pull-through technique (TERPT) from 2005 to 2017 were invited to participate. Ultrasound of the urinary tract was performed postoperatively. Children >4 years were asked to answer a urinary tract function questionnaire. Controls were age-matched healthy children. Ethical approval was obtained.
Results:
Seventy two children with HD and TERPT were included. Ultrasound was performed in 58 children (83%) post-TERPT. Ten anomalies were diagnosed in six children (10%). Structural anomalies included abnormal kidney size (7%), renal agenesis (2%), prominent calyces (2%) and renal pelvis anomaly (25). Probable acquired anomalies included hydronephrosis (2%), hydroureter (2%) and parenchymal damage (2%). One child had a prior nephrectomy owing to a Wilms' tumor. All 37 children >4 years (27 boys and 10 girls), median aged 8 years (range 4-12), answered the questionnaire as did 284 healthy controls (144 boys and 140 girls). Boys with HD reported a higher frequency of enuresis: 65% versus 9% (p = 0.001) and urinary tract infections: 18% versus 3% (p = 0.012). Girls with HD reported enuresis more frequently (60%) than healthy girls (7%) (p = 0.001). Children with HD with constipation reported enuresis more frequently (p = 0.038).
Conclusions:
Urinary tract anomalies and dysfunction deserve attention in the follow-up of children with HD. We suggest screening for urinary tract anomalies and urinary tract symptoms in follow-up of children with HD.
Type Of Study:
Treatment study.
Level:
III.
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