Epididymo-orchitis complicating anorectal malformations: collective review of 41 cases

J Urol. 2011 Oct;186(4):1467-72. doi: 10.1016/j.juro.2011.05.066.


Purpose: Epididymo-orchitis is a devastating complication of imperforate anus. Without proper treatment the condition may result in infertility. Nevertheless, the exact etiology and optimal management of epididymo-orchitis in anorectal malformation are unknown.

Materials and methods: Retrospective review of our hospital records between 1997 and 2010 identified 6 cases of epididymo-orchitis in 82 boys with anorectal malformation. Extensive search of the literature revealed 35 additional cases. Clinical details of these 41 patients were analyzed using chi-square testing.

Results: Epididymo-orchitis occurred predominantly (86%) in high or intermediate anorectal malformation with rectourinary fistula. Median age at onset of epididymo-orchitis was 6 months and there was no side predilection. Urinary tract infection was noted in 54% of patients. Persistent mesonephric duct syndrome (27%), urethroejaculatory duct reflux (22%), vasovesical ectopia (10%), neurovesical dysfunction (34%) and urethral stricture/stenosis (17%) were frequently associated risk factors for epididymo-orchitis. In 73% of patients epididymo-orchitis recurred with exclusive antibiotic treatment. Diverting colostomy was ineffective in preventing epididymo-orchitis. Division of rectourinary fistula was curative in 36% of patients, while in 34% epididymo-orchitis recurred even after division of rectourinary fistula. Division of rectourinary fistula is likely to resolve epididymo-orchitis in the absence of additional risk factors. Vasectomy was required in 22% of patients to prevent recurrence.

Conclusions: In addition to rectourinary fistula, urinary reflux into the vas deferens and neurovesical dysfunction are major risk factors for epididymo-orchitis in anorectal malformation. Division of rectourinary fistula is curative in only a third of cases. In the remaining cases some form of surgical disruption of the vas deferens is needed to resolve recurrent epididymo-orchitis.

MeSH terms

  • Anorectal Malformations
  • Anus, Imperforate / complications*
  • Epididymitis / diagnosis
  • Epididymitis / etiology*
  • Epididymitis / therapy
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Orchitis / diagnosis
  • Orchitis / etiology*
  • Orchitis / therapy
  • Rectal Fistula / complications
  • Risk Factors
  • Urinary Bladder Fistula / complications
  • Vas Deferens / abnormalities
  • Wolffian Ducts / abnormalities