Pediatric Urological Surgery

What is a Urinary Tract Infection?

Urinary tract infection is a result of the growth of bacteria within the child's urinary tract. This will usually cause varying degrees of inflammation of such organs as the kidneys or bladder. The most reliable means of diagnosis is made by obtaining a urine culture. Even this method is not foolproof, as the urine may be contaminated by bacteria on the child's skin when voiding. Occasionally, to avoid confusion and assure greater diagnostic accuracy, a urine sample can be obtained by passing a small urethral catheter or performing a suprapubic needle aspiration. The bacteria causing these infections are present in the child's own intestinal tract and probably ascend into the urinary tract. They are absolutely not contagious to others.

Symptoms Associated with Urinary Tract Infections

Symptoms are often misleading. In infants (less than 2 years old) they are usually non-specific and may not focus your attention towards the urinary tract. On the other hand, urinary frequency and discomfort associated with voiding in children may simply result from irritations that mimic a urinary tract infection. It is essential to obtain a urine culture to both avoid missing the diagnosis of UTI, as well as overdiagnosing UTI in children.

INFANTS (<2)	CHILDREN (>2)
Fever	Fever
Irritability	Frequency, Urgency
Malodorous Urine	Wetting
Failure to Thrive	Burning

What radiologic studies are indicated in children with Urinary Tract Infection?

A history and physical exam is not sufficiently accurate to evaluate the child's urinary tract. Adequate evaluation of the "upper" and "lower" urinary tract requires the proper selection of different radiologic studies. The initial study should be a voiding cystourethroeram (VCUG) to demonstrate the anatomy of the "lower" urinary tract. The VCUG is performed by placing a small catheter into the bladder and allowing a water-like contrast material to pass through the catheter filling the bladder. A few X-ray films are taken during bladder filling and voiding to observe for reflux or urine. The "upper" urinary tract may require one or more of the following studies:

1. An IVP demonstrates the anatomy and some information as to the function and drainage of the kidneys. An injection (needle) of iodine contrast into the child's vein precedes the X-rays.
2. A Renal Ultrasound can visualize the kidneys and rule out obvious obstructions. There are no injections or catheters necessary for this test.
3. A Renal Scan, performed in the Nuclear Medicine Department, is mot accurate in estimating kidney function and drainage, as well as detecting evidence of kidney involvement (scarring). An injection of radioisotope into the child's vein is required before scanning.

How are Urinary Tract Infections Treated?

Prompt and effective treatment followed by adequate evaluation of the urinary tract is essential to minimize your child's discomfort and risk of urinary tract damage. Your physician will usually prescribe an oral antibiotic for a period of 5-7 days to treat a "simple" UTI. To treat a more "complicated" UTI (babies less than 2 months old, child appears ill, high fevers, poor response to initial oral antibiotic), your physician may decide to hospitalize your child and begin intravenous antibiotics. In these cases where a kidney infection is suspected, the course of antibiotics will be 10-14 days. Unfortunately, it is not uncommon for a urinary tract infection to recur (especially in girls) after initially adequate antibiotic treatment, even with normal radiologic studies. This may be most perplexing to parents and physicians, but there is little chance of significant damage to the urinary system when the radiologic studies are normal. Further invasive studies such as cystoscopy, urethral dilation or repeat VCUG are not indicated or useful. It is important to have your physician perform follow-up urine cultures whenever another UTI is suspected. and routinely every 3 months for at least one year following treatment. There are children who demonstrate a strong tendency towards recurrent UTI (>3/year) and 1 recommend continuous low dose antibiotic prophylaxis, as a nightly dose for at least 6 months.

[ top ]