Epididymis Vas and Ejaculatory Ducts

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There is an increased incidence of epididymitis in ARM boys and this is seen prior to and after surgical closure of rectourinary fistula [8,35]. The exact mechanism for this is unknown, but abnormalities such as urethral strictures, ectopic ureters, diverticulum at the previous fistula site, and a neurogenic bladder may all be contributory factors. Ectopia of the vas has been reported [28], and Wolffian duct abnormalities are more common on the same side as renal anomalies [23]. The vas and seminal vesicles are prone to iatrogenic injury in patients with prostatic and bladder neck fistulas [11]. Holt et al. reported a high incidence of male infertility in adult males treated for ARM. Half of the groups studied were azospermic and there was a high incidence of ejaculatory problems [23]. This highlights the importance of treating recurrent epididymitis, performing early orchidopexy, and referring these patients to adolescent urology for assessment in early adult life.

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