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Risk factors of vesicoureteral reflux and urinary tract infections in children with imperforate anus: A
Chung-Wei Wu1, Chang-Ching Wei1,2, Cheng-Li Lin3,4
1Division of Pediatric Nephrology, Children's Hospital of China Medical University, Taichung, Taiwan.
Insights
Children with high-position imperforate anus (IA) face increased risks of urinary tract infections (UTI) and vesicoureteral reflux (VUR). Early screening for these conditions is crucial to prevent kidney damage.
Area of Science:
- Pediatric Urology
- Medical Informatics
Background:
- Imperforate anus (IA) is frequently linked to urological anomalies, notably vesicoureteral reflux (VUR), a significant cause of morbidity in patients with anorectal malformations.
- Understanding the risk factors for VUR and urinary tract infections (UTI) in children with IA is critical for timely intervention and improved patient outcomes.
Purpose of the Study:
- To identify risk factors associated with vesicoureteral reflux (VUR) and urinary tract infections (UTI) in pediatric patients diagnosed with imperforate anus (IA).
- To estimate the prevalence of congenital anomalies of the kidney and urinary tract (CAKUT) in children with IA and analyze their association with VUR.
Main Methods:
- Retrospective analysis of the National Health Insurance Research Database (NHIRD) from 2000 to 2008.
- Inclusion of 613 children with imperforate anus (IA), categorized by IA position (high vs. low) and presence of co-occurring conditions.
- Statistical analysis using odds ratios (OR) and 95% confidence intervals (CI) to determine risk factors for VUR.
Main Results:
- High-position IA significantly increased the risk of VUR (OR: 2.68) compared to low-position IA.
- Children with IA and co-existing CAKUT, hydronephrosis, or UTI exhibited substantially higher risks of VUR (ORs ranging from 7.65 to 31.8).
- UTI and chromosomal anomalies were more prevalent in the high-position IA group.
Conclusions:
- Patients with high-position IA, especially those with CAKUT, hydronephrosis, or UTI, have an elevated risk of VUR.
- Periodic urinalysis for UTI screening and early voiding cystourethrograms are recommended for high-risk IA patients to prevent renal damage.
- Consideration of chromosomal analysis is advised for high-position IA cases to rule out conditions like Down syndrome.
Abstract:
Imperforate anus (IA) is associated with several urological anomalies, including vesicoureteral reflux (VUR), a major contributor to high morbidity in patients with anorectal malformations. This retrospective study was performed to elucidate the risk factors of vesicoureteral reflux (VUR) and UTI in children with IA.We used the National Health Insurance Research Database (NHIRD) to estimate the frequency of congenital anomalies of the kidney and urinary tract (CAKUT) in children with IA. We also investigated the frequencies of VUR, UTI, and CAKUT in children with IA along with the risk factors of VUR.We enrolled 613 children between 2000 and 2008 (367 males and 246 females; 489 low-position IA and 124 high-position IA). High-position IA was associated with a significantly increased risk of VUR compared with low-position IA (OR: 2.68, 95% CI: 1.61, 4.45). In addition, children with IA along with CAKUT, hydronephrosis, or UTI had a higher risk of VUR (OR: 8.57, 95% CI: 3.75, 19.6; OR: 7.65, 95% CI: 4.48, 13.1; and OR: 31.8, 95% CI: 11.5, 88.3, respectively). UTI, as well as chromosomal anomalies, were more frequent in children with high-position IA.Patients with a high-position IA had a greater risk of VUR, particularly those with CAKUT, hydronephrosis, or UTI. Such patients must periodically undergo urinalysis to screen for UTI and early voiding cystourethrogram to rule out VUR and prevent consequent renal damage. Chromosomal analysis is suggested to rule out Down syndrome.
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