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Pediatric Radiology
Published in: Pediatric Radiology 5/2019

01-05-2019 | Ultrasound | Original Article

Comparison of diagnostic accuracy for fistulae at ultrasound and voiding cystourethrogram in neonates with anorectal malformation

Authors: Takahiro Hosokawa, Yoshitake Yamada, Yutaka Tanami, Yumiko Sato, Tetsuya Ishimaru, Yujiro Tanaka, Hiroshi Kawashima, Eiji Oguma

Published in: Pediatric Radiology | Issue 5/2019

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Abstract

Background

Recently, it has been reported that anorectal malformation with rectourethral fistula in male neonates can be managed by primary neonatal reconstruction without colostomy. To prevent urethral injury during anorectoplasty, the fistula’s location is important. To date, the use of voiding cystourethrograms to determine the presence and location of fistulas in neonates with anorectal malformations has not been studied.

Objective

To compare the accuracy of ultrasound (US) and voiding cystourethrogram for determining the presence and location of fistulas in neonates with anorectal malformation.

Materials and methods

We included 21 male neonates with anorectal malformation with rectourethral fistula (n=16), rectovesical fistula (n=1) or no fistula (n=4) who underwent US and voiding cystourethrogram preoperatively on the day of surgery. Fistula imaging was classified into three grades (0–2), and grades 1–2 were considered fistula positive. We compared the imaging-based location of the fistula with surgical findings.

Results

US performed significantly better than voiding cystourethrogram for determining the presence of fistulas (area under the receiver operating characteristic curve, 0.90 vs. 0.71, respectively; P=0.044) (diagnostic accuracy 85.7%, 95% confidence interval [95% CI] 63.7–97.0% and 52.4%, 95% CI 29.8–74.3%, respectively). In cases with fistulas detected by either modality, the accuracy of locating the fistula by US was 50.0% (95% CI 24.7–75.3%) and by voiding cystourethrogram was 100% (95% CI: 59.0–100%).

Conclusion

US accurately detected, but did not accurately locate, fistulas in neonates with anorectal malformation. When planning primary neonatal reconstruction of anorectal malformation without colostomy, voiding cystourethrogram could provide additional information about fistula location.
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Metadata
Title
Comparison of diagnostic accuracy for fistulae at ultrasound and voiding cystourethrogram in neonates with anorectal malformation
Authors
Takahiro Hosokawa
Yoshitake Yamada
Yutaka Tanami
Yumiko Sato
Tetsuya Ishimaru
Yujiro Tanaka
Hiroshi Kawashima
Eiji Oguma
Publication date
01-05-2019
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 5/2019
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-018-04339-4

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