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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 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.
| Fever |
Fever |
| Irritability |
Frequency, Urgency |
| Malodorous Urine |
Wetting |
| Failure to Thrive |
Burning |
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:
- 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.
- A Renal Ultrasound can visualize the kidneys
and rule out obvious obstructions. There are
no injections or catheters necessary for this
test.
- 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.
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.
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Pediatric Urological Surgery
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Conditions Parents Should Know About
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