Congenital Pouch Colon in Males: Exploring the Risk of Epididymo-orchitis

Patients with anorectal malformations (ARMs) are known to have a higher association with epididymo-orchitis (EO). Congenital pouch colon (CPC), a rare subtype of ARM, presents with several predisposing factors that are presumed to be linked with EO. This study aims to investigate the occurrence of EO in this specific subgroup of ARM patients to enhance the understanding of its etiology.

An ambispective observational study was conducted by analyzing medical records of male patients with CPC. Out of 28 patients managed primarily at our center, 25 fulfilled the inclusion criteria. The mean age at follow-up was 3.36 ± 1.33 years. Type IV CPC was the most common, seen in 12 (45.8%) patients. Hydroureteronephrosis was detected in 13 patients at initial presentation via abdominal ultrasonography, and 7 (28%) patients had a history of urinary tract infection (UTI). Cystoscopic evaluation revealed an ascended verumontanum into the bladder neck with the colovesical fistula near the verumontanum in nine patients. Only one patient, who had recurrent UTIs since infancy and voiding difficulties, experienced two episodes of EO. This patient also had multiple associated genitourinary and spinal anomalies. None of the remaining patients developed EO.

Despite the anatomical abnormalities associated with CPC, only 1 out of the 25 patients developed EO. Early division of the pouch vesical fistula and minimal dissection around the prostatic urethra may significantly reduce the risk of EO in this population. However, further research involving larger patient cohorts is necessary to better understand the underlying mechanisms and validate these observations.