Tract Infection In Boys Research Articles

MP70-13 THE EFFECT OF CIRCUMCISION/CONTINUOUS ANTIBIOTIC PROPHYLAXIS ON PREVENTING THE RECURRENCE OF FEBRILE URINARY TRACT INFECTION IN BOYS WITH PRIMARY VESICOURETERAL REFLUX

You have accessJournal of UrologyCME1 Apr 2023MP70-13 THE EFFECT OF CIRCUMCISION/CONTINUOUS ANTIBIOTIC PROPHYLAXIS ON PREVENTING THE RECURRENCE OF FEBRILE URINARY TRACT INFECTION IN BOYS WITH PRIMARY VESICOURETERAL REFLUX Fang Chen and Yichen Huang Fang ChenFang Chen More articles by this author and Yichen HuangYichen Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To explore the preventing effect of circumcision and continuous antibiotic prophylaxis on the recurrence of febrile urinary tract infection in boys with primary vesicoureteral reflux. METHODS: The clinical data of 88 boys with primary vesicoureteral reflux diagnosed in our hospital were retrospectively analyzed. The median age of the enrolled children was 10.2 months, and the average age was (15.3±15.9) months. The 88 boys were divided into 4 groups, including 3 cases in the watchful waiting group, 50 cases in the continuous antibiotic prophylaxis group, 22 cases in the circumcision group, and 13 cases in the continuous antibiotic prophylaxis+circumcision group. The follow-up time was 1 to 3 years. The recurrence of febrile urinary tract infection in each group was counted, and the effective conservative treatment strategy was analyzed. RESULTS: There were 21 cases (23.9%) of febrile urinary tract infection recurrence among 88 children, 2 cases (66.7%) in the watchful waiting group, 16 cases (32.0%) in the continuous antibiotic prophylaxis group, and 3 cases in the circumcision group (13.6) %). There was no recurrence in 13 patients in the continuous antibiotic prophylaxis+circumcision group. There was a statistical difference in the recurrence rate between the 4 treatment groups (χ2=10.181, p=0.011). Factorial analysis suggests that circumcision is the main factor in reducing the recurrence of febrile urinary tract infections (p=0.003). CONCLUSIONS: For boys with primary vesicoureteral reflux, circumcision is the main factor in reducing the recurrence of febrile urinary tract infections. Circumcision combined with continuous antibiotic prophylaxis can prevent the recurrence of febrile urinary tract infection to the greatest extent. There is no significant difference between continuous antibiotic prophylaxis and watchful waiting in preventing the recurrence of febrile urinary tract infection. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1008 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fang Chen More articles by this author Yichen Huang More articles by this author Expand All Advertisement PDF downloadLoading ...

Risk factors for febrile urinary tract infection in boys with posterior urethral valves.

ObjectiveBoys with posterior urethral valves (PUV) present an increased risk of febrile urinary tract infection (fUTI). Identifying specific risk factors could allow for tailoring UTI prevention. The aim of this study was to use the data from the CIRCUP randomized controlled trial data to identify patient characteristics associated with a higher risk of fUTI.Patients and methodsWe performed a secondary analysis of the data from the CIRCUP randomized trial which included boys with PUV, randomized to circumcision and antibiotic prophylaxis vs. antibiotic prophylaxis alone and followed for 2 years. There was only 1 episode of fUTI in the circumcision group vs. 17 in the uncircumcised group. We therefore only studied the antibiotic prophylaxis alone group and compared age at prenatal diagnosis, size and weight at birth, presence of dilating VUR at diagnosis, abnormal DMSA scan at 2 months, and nadir creatinine between children who presented a fUTI and those who did not, as well as age at first episode of fUTI.ResultsThe study group consisted of 42 patients of which 17 presented at least on fUTI. Presence of dilating VUR was significantly associated with risk of fUTI (p = 0.03), OR: 6 [CI 95% = (1.13–27.52)]. None of the other parameters were associated with increased risk of fUTI. We observed three distinct time periods for presenting a fUTI with a decrease in infection rate after the first 40 days of life, then at 240 days of life.ConclusionIn boys with PUV, presence of high-grade VUR is associated with a higher risk of presenting a fUTI. The rate of febrile UTIs seems to decrease after 9 months.

The benefits of circumcision in boys with posterior urethral valves.

Journal of Paediatrics and Child HealthVolume 58, Issue 10 p. 1908-1909 Heads UpFree Access The benefits of circumcision in boys with posterior urethral valves First published: 11 September 2022 https://doi.org/10.1111/jpc.16201 edited by Craig Mellis (craig.mellis@sydney.edu.au) AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Posterior urethral valves (PUVs) affect 1 in 4000 male births, with a life-time risk of end-stage renal disease of 28.5%. Despite post-natal management with valve ablation, PUVs still pose an increased risk of febrile urinary tract infections (fUTIs), and possible acquired renal injury. A collaboration between 13 French referral centres was recently published to determine the utility of circumcision in boys with PUVs.1 Neonates with a diagnosis of PUVs were recruited and randomised (93 in total) to either circumcision with prophylactic antibiotics, or prophylactic antibiotics alone. A fUTI was defined by a fever of >38.5°C with concomitant pyuria and culture-positive infection on urinalysis (obtained by suprapubic aspiration or catheterisation). Following two years of follow-up, the risk of febrile UTI was 3% among boys in the treatment arm, compared to 20% in the control group, translating to a tenfold risk reduction of fUTI, and a number needed to treat of six children to prevent one fUTI. This was a well-constructed study providing objective evidence for what has generally been considered a worthwhile procedure on an intuitive basis. The above French randomised trial provides valuable evidence to inform discussions of the benefits of medical circumcision in the context of PUV. Reference 1Harper L, Blanc T, Peycelon M et al. Circumcision and risk of febrile urinary tract infection in boys with posterior urethral valves: Result of the CIRCUP randomized trial. Eur. Urol. 2022; 81: 64– 72. CrossrefCASPubMedWeb of Science®Google Scholar Reviewers: Kiarash Taghavi, kiarash.taghavi@monashhealth.org and Chris Kimber, ckimber@bigpond.net.au, Department of Paediatric Urology, Monash Children's Hospital, Melbourne, Australia. Kai Zheong Lim, teddylimkz@outlook.com, Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia. Volume58, Issue10October 2022Pages 1908-1909 ReferencesRelatedInformation

Neonatal Circumcision in Boys With Posterior Urethral Valves

Source: Harper L, Blanc T, Peycelon M, et al. Circumcision and risk of febrile urinary tract infection in boys with posterior urethral valves: result of the CIRCUP randomized trial. Eur Urol. 2022;81(1):64-72; doi:10.1016/j.eururo.2021.08.024Investigators from multiple institutions in France conducted a randomized controlled trial to assess the effect of circumcision on the risk of febrile urinary tract infection (fUTI) in infant boys with posterior urethral valves (PUV). Participants were male neonates 1-28 days old with PUV diagnosed by voiding cystogram, who were enrolled between 2012 and 2017 at 13 pediatric urology centers. Study patients were randomized to circumcision and antibiotic prophylaxis (CATB), or antibiotic prophylaxis alone (ATB) treatment groups. Circumcision was performed at the time of valve resection under general anesthesia. Antibiotic prophylaxis consisted of cefaclor 10 mg/kg/day for 1 month, followed by cotrimoxazole (15 mg/kg/day) until participants were 2 years old. A technetium-99m dimercaptosuccinic acid (DMSA) scan was performed when patients were 1-2 months and 2 years of age to evaluate renal damage. Study children were followed for 2 years. The primary outcome was fUTI, defined as culture-proven infection (≥103 bacteria/mL in catheterized specimens and ≥104 bacteria/mL for urine specimens obtained by suprapubic aspiration) with pyuria, in the presence of fever (>38.5° C) and signs of inflammation (leukocytosis, elevated C-reactive protein, and/or procalcitonin). The risk of fUTI in the 2 treatment groups was assessed using Kaplan-Meier analysis, and Cox regression was used to compare the risks. Adherence to antibiotic prophylaxis was assessed throughout the 2-year follow-up period and compared between groups. Evidence of increased renal damage between the initial and follow-up DMSA scans was determined and compared in those with and without fUTI with a chi-square test.Data were analyzed on 91 boys, including 49 randomized to CATB and 42 to the ATB group; the mean age at enrollment was 4.3 ± 5.0 and 7.1 ± 6.7 days, respectively, and mean age at valve resection was 5.2 ± 5.4 and 9.4 ± 11.6 days, respectively. A total of 64 (70%) children completed the entire 2-year follow-up period (33 in the CATB group and 31 in the ATB group). Overall, the risk of fUTI was 20% in the ATB group and 3% in those randomized to circumcision (hazard ratio [HR], 10.3; 95% CI, 1.3, 82.5). Adherence to the antibiotic prophylaxis regimen declined in participants during the study period but was not significantly different between treatment groups. At the time of the initial DMSA scan, 63% of children had abnormalities identified, and deterioration on DMSA scans was noted on 18% at follow-up, including 33% of those with a history of fUTI and 16% without fUTI (P = 0.29).The authors conclude circumcision decreased the risk of fUTI in boys born with PUV.Dr Sanchez-Kazi has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The prevalence of fUTI is highest during the newborn period in boys with PUV.1 fUTI increases the risk of renal scarring, which can lead to chronic kidney disease. (See AAP Grand Rounds. 2019;42(5):53.)2 The current investigators evaluated whether circumcision reduces the risk of fUTI in boys with PUV. Although the results showed that CATB lowered the risk of fUTI, there was no difference between groups in the degree of kidney scarring as shown on the DMSA scans. Although it may be possible that this lack of significant change is explained by a lower number of participants, high attrition rate, variability in the radiographic interpretation of the DMSAs, short period of follow-up, or the inherent abnormal kidney parenchyma in boys with PUV due to possible dysplasia. However, the most likely explanation is that despite a substantial effect size (the rate of worsening DMSA scans was >2 times higher in those with fUTI than those without), there was insufficient power to detect a statistically significant difference in the outcomes.As stated in the accompanying editorial, circumcision reduced the occurrence of fUTI, but it did not decrease morbidity or mortality related to kidney scars.3 Steroid cream is currently used to manage phimosis in uncircumcised infants with fUTI.4 Will a retractable foreskin have the same advantage in infants with PUV?4 In boys with PUV however, neurogenic bladder and hydronephrosis are additional factors that significantly increase the probability of fUTI.1 In the most recent AAP Policy Statement on Circumcision in boys with a normal urinary tract, the committee left the decision-making to parents.5 The Canadian Urological Association also recommends early parental discussion of circumcision in the presence of an abnormal urinary tract including PUV, since the risk of fUTI is highest within the first 3 months of life.1,6 The results of the current study hopefully will contribute to more knowledgeable parental decision making.Neonatal circumcision in boys with posterior urethral valve decreases the risk of fUTI.

Circumcision and Risk of Febrile Urinary Tract Infection in Boys with Posterior Urethral Valves: Result of the CIRCUP Randomized Trial

BackgroundBoys with posterior urethral valves (PUVs) have an increased risk of febrile urinary tract infections (fUTIs). Circumcision is believed to reduce the risk of fUTIs in boys, although there are no randomized trials demonstrating this. ObjectiveTo determine the effect of circumcision on the risk of fUTIs in boys with PUVs. Design, setting, and participantsA clinical randomized trial that ran between August 2012 and July 2017 was conducted. The trial was multicentric, including 13 referral centers for pediatric urology. Male boys, aged 1–28 d, diagnosed with posterior urethral valves, confirmed by voiding cystogram, were included. The exclusion criteria included presence of a genital malformation contraindicating performing a circumcision. InterventionParticipants were randomized to neonatal circumcision + antibiotic prophylaxis (CATB) or antibiotic prophylaxis alone (ATB), and followed for 2 yr. Outcome measurements and statistical analysisThe primary outcome was a risk of presenting fUTIs in each group. An fUTI was defined as fever (>38.5 °C) with evidence of pyuria and culture-proven infection on urinalysis, obtained by urethral catheterization or suprapubic aspiration. A bivariate analysis of the primary outcome was performed using the Kaplan-Meier method. Results and limitationsIn total, 91 patients were included: 49 in group CATB and 42 in group ATB. The probability of presenting an fUTI was 20% in group ATB versus 3% in group CATB. The hazard ratio of presenting an fUTI within 2 yr in the ATB group compared with that in the CATB group was 10.3 (95% confidence interval: 1.3–82.5). Sixty-four children (70.3%) had a complete follow-up at 2 yr of age. ConclusionsCircumcision significantly decreases the risk of presenting an fUTI in boys with PUVs. Patient summaryIn this report, we compared, in a multicentric trial, the number of febrile urinary tract infections (UTIs) in boys with posterior urethral valves who had either antibiotic prophylaxis alone or antibiotic prophylaxis and circumcision. We found that those who had a circumcision had a significantly lower risk of febrile UTIs.

Urinary Tract Infection in Boys with Hypospadias

The aim of this study was to evaluate the frequency of urinary tract infections (UTI) in boys with hypospadias pre- peri- and post-operatively in order to determine whether antibiotic prophylaxis for UTI is warranted when they undergo a reconstructive surgery for hypospadias. Included in the study group were 174 boys undergoing reconstructions for hypospadias. The control group comprised 204 boys operated on for an inguinal hernia. The main outcome measure was the documented finding of a urinary tract infection verified by a positive bacteria culture. The results revealed a significant difference in the findings of a positive urinary culture between the boys undergoing hypospadias surgery, 7.5%, and those operated on for an inguinal hernia, 1.5%, (p = 0.0044). The difference between the groups was not significant in the pre- and peri-operative periods. A higher incidence of infections was noted in boys who had other congenital malformations in addition to hypospadias (P = 0.02). Thus, the boys with hypospadias are more likely to incur a urinary tract infection. Since the results did not show a higher incidence of symptomatic urinary tract infections shortly after the surgery, it may not be advantageous to administer prophylactic antibiotics to decrease the number of urinary tract infections. However, comparison of subgroups consisting of the hypospadias without and with prophylactic antibiotics remains to be conducted.

Prenatal exposure to p,p′-DDE and p,p′-DDT in relation to lower respiratory tract infections in boys from a highly exposed area of Mexico

BackgroundPrenatal exposure to 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p′-DDE), the major breakdown product of DDT, has been associated with recurrent lower respiratory tract infections (LRTIs) in infants. However, epidemiological investigations are limited. ObjectiveTo assess the association of prenatal exposure to p,p′-DDE and p,p′-DDT with the occurrence of LRTI in boys from Chiapas, a highly exposed area of Mexico. MethodsWe analyzed data from 747 singleton boys whose prenatal exposure to p,p′-DDE and p,p′-DDT was determined in maternal serum drawn at delivery (2002–2003). LRTI (i.e., pneumonia, bronchiolitis, and other illness of the bronchi) experienced by the children were reported by their mothers during in-person interviews. The median age of the children when they were last seen was 21.4 months (quartiles 19.1 and 25.3 months). ResultsMedian exposure to p,p′-DDE in this population was higher (2.7µg/g lipid) than recent U.S. levels (0.20µg/g). There were 0.19 episodes of LRTI per child-year. After adjusting for potential confounders, children in the highest category of p,p′-DDE (>9.00µg/g) exposure compared to those in the lowest (≤3.00µg/g) had an adjusted incidence rate ratio (aIRR) of LRTI of 0.77 (95% confidence interval [CI], 0.41–1.46). The corresponding aIRR for p,p′-DDT (≥2.00µg/g compared to ≤0.25µg/g) was 0.65 (95% CI: 0.30–1.39). ConclusionAn association of prenatal exposure to p,p′-DDE and p,p′-DDT with LRTI during childhood was not supported in this population with relatively high levels of exposure.

Is VCUG Still Indicated Following the First Episode of Urinary Tract Infection in Boys?

To determine if voiding cystourethrogram (VCUG) following first episode of urinary tract infection (UTI) offers any incremental diagnostic advantage in boys if a comprehensive renal and bladder ultrasonogram (RBUS) revealed no abnormalities. All boys less than 10 years of age whose first evaluation for UTI included RBUS and VCUG were retrospectively studied over a 10-year period. Those with a disorder of the urinary tract known before imaging were excluded. RBUS and VCUG results were analyzed. Of the 77 who met the inclusion criteria, 58 (77%) were <1 year old. 45 (58%) boys had normal RBUS and VCUG. In 16 (21%) both studies were abnormal: 15 had vesicoureteral reflux (VUR) and one had posterior urethral valves. The remaining 16 (21%) had one abnormal study: 10 had pelvicaliectasis on RBUS without VUR; 6 had normal RBUS with VUR. No urethral abnormality was diagnosed on VCUG when RBUS was normal. Of the six who had VUR and normal RBUS, the one who required surgical intervention had recurrent febrile UTI. If a well-performed RBUS is normal in a boy with first UTI, the likelihood of a significant finding in VCUG is low. A VCUG is likewise of no apparent screening benefit for obstructive uropathy. With the uncertainties surrounding the benefit of chemoprophylaxis, omitting a VCUG when a RBUS is normal in boys with a first UTI avoids the morbidity without missing important pathologies or altering evolving management protocols.

Circumcision and Lifetime Risk of Urinary Tract Infection: A Systematic Review and Meta-Analysis

Urinary tract infection is common in infant males who are uncircumcised and can lead to renal parenchymal disease of the still growing pediatric kidney. Although the rate of urinary tract infection is highest in the first year of life, the cumulative incidence during the rest of the lifetime is under-recognized, but is expected to be nontrivial. Thus, any intervention that might prevent urinary tract infection would be expected to reduce suffering and medical costs. We conducted a meta-analysis of 22 studies examining the single risk factor of lack of circumcision, then determined the prevalence and relative risk of urinary tract infection in different age groups (0 to 1, 1 to 16 and older than 16 years). From these data we estimated the lifetime prevalence. For age 0 to 1 year the relative risk was 9.91 (95% CI 7.49-13.1), for age 1 to 16 years RR was 6.56 (95% CI 3.26-13.2) and for older than 16 years it was 3.41-fold (95% CI 0.916-12.7) higher in uncircumcised males. We then calculated that 32.1% (95% CI 15.6-49.8) of uncircumcised males experience a urinary tract infection in their lifetime compared with 8.8% (95% CI 4.15-13.2) of circumcised males (RR 3.65, 95% CI 1.15-11.8). The number needed to treat was 4.29 (95% CI 2.20-27.2). The single risk factor of lack of circumcision confers a 23.3% chance of urinary tract infection during the lifetime. This greatly exceeds the prevalence of circumcision complications (1.5%), which are mostly minor. The potential seriousness of urinary tract infection supports circumcision as a desirable preventive health intervention in infant males.

Are Antibiotics Necessary for Pediatric Epididymitis?

To determine the percentage of cases of epididymitis in pediatric patients that is of bacterial cause and to identify factors that predict a positive urine culture. We conducted a retrospective chart review of patients diagnosed with acute epididymitis or epididymo-orchitis in 1 pediatric emergency department for 11 years. Charts were reviewed for historical, physical, laboratory, and radiologic data. A positive urine culture was used to identify patients with a bacterial cause of epididymitis. A total of 160 patient records were initially identified as having a diagnosis of epididymitis; of these, 20 met exclusion criteria or did not have records available for review and 140 cases of epididymitis were reviewed. Patients' age ranged from 2 months to 17 years, with a median age of 11 years. Of these patients, 91% received empiric antibiotic therapy. Also, of these patients, 97 (69%) had a urine culture sent, of whom 4 (4.1%; 95% confidence interval, 1.1%-10.2%) were positive. Of the 4 positive urine cultures, 3 had organisms not sensitive to usual empiric therapy for urinary tract infections. The boys with positive urine cultures were not significantly different from the other patients in age, maximum temperature, or number of white blood cells on urinalysis. Given the low incidence of urinary tract infections in boys with epididymitis, in prepubertal patients, antibiotic therapy can be reserved for young infants and those with pyuria or positive urine cultures. Because it is difficult to predict which patients will have a positive urine culture, urine cultures should be sent on all pediatric patients with epididymitis.

What is the effect of circumcision on risk of urinary tract infection in boys with posterior urethral valves?

Purpose Boys with posterior urethral valves (PUV) have increased risks of urinary tract infection (UTI) voiding dysfunction and ongoing renal damage. Circumcision has been shown epidemiologically to reduce UTIs, but no trial has yet confirmed this in PUV. Circumcision is not routinely performed in boys with PUV in our unit, but one quarter of our patients are circumcised for religious reasons. It may be hypothesized that circumcision reduces the risk of subsequent urinary tract infection in boys with PUV. This study aims to test this hypothesis by comparing the risk of UTI, and subsequent renal outcome, in PUV in uncircumcised boys with those who were circumcised. Methods A retrospective cross-sectional case note review of boys with PUV was performed, and the following were documented: age at presentation, method of diagnosis, method of treatment, initial renal status, and timing of treatment; use and timing of urinary tract diversion; timing of circumcision; and UTIs—date, organism, and treatment. Results Seventy-eight patients were identified, mean age 6.7 years (range, 1-18). These boys experienced 78 UTIs in the uncircumcised state. Subsequently, 27 were circumcised, experiencing 8 UTIs. Eighteen boys were diverted. The incidence of UTI was reduced from 0.50 ± 0.14 (mean ± SEM) UTIs annually uncircumcised to 0.09 ± 0.02 (mean ± SEM) circumcised ( P < .01, Student's t test). Conclusion In PUV, circumcision reduces the incidence of UTI by 83%, every circumcision prevents 1 UTI on average. Early circumcision in all PUV is beneficial, but a larger randomised control trial should be considered to confirm this.

Antibiotic Prophylaxis for the Prevention of Recurrent Urinary Tract Infection in Children With Low Grade Vesicoureteral Reflux: Results From a Prospective Randomized Study

Antibiotic prophylaxis is given to children at risk for urinary tract infection. However, evidence concerning its effectiveness in grade I to III vesicoureteral reflux is lacking. The objective of this study was to determine whether antibiotic prophylaxis reduces the incidence of urinary tract infection in young children with low grade vesicoureteral reflux. Children 1 month to 3 years old with grade I to III vesicoureteral reflux were assigned randomly to receive daily cotrimoxazole or no treatment, and followed for 18 months. A urinary tract infection constituted an exit criterion. Infection-free survival rates were calculated using the Kaplan-Meier method and compared using the log rank test. A total of 225 children were enrolled in the study. Distribution of gender, age at inclusion and reflux grade were similar between the 2 groups. There was no significant difference in the occurrence of urinary tract infection between the 2 groups (17% vs 26%, p = 0.2). However, a significant association was found between treatment and patient gender (p = 0.017). Prophylaxis significantly reduced urinary tract infection in boys (p = 0.013), most notably in boys with grade III vesicoureteral reflux (p = 0.042). These data suggest that antibiotic prophylaxis does not reduce the overall incidence of urinary tract infection in children with low grade vesicoureteral reflux. However, such a strategy may prevent further urinary tract infection in boys with grade III reflux.

Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies

Objective: To undertake a meta-analysis of published data on the effect of circumcision on the risk of urinary tract infection (UTI) in boys. Data sources: Randomised controlled trials and observational...

FEBRILE URINARY TRACT INFECTIONS IN INFANTS: RENAL ULTRASOUND REMAINS NECESSARY

Current guidelines from the American Academy of Pediatrics recommend voiding cystourethrography (VCUG) and renal ultrasound for the radiographic evaluation of infants after a febrile urinary tract infection. Some recent studies have suggested that ultrasound is not necessary in the era of prenatal ultrasound. We reviewed our experience to ascertain the influence that ultrasound has on the treatment of these infants. We reviewed retrospectively the charts of 282 consecutive patients (5 days to 6 months old, 98 males and 184 females) who underwent radiographic evaluation for a febrile urinary tract infection between October 1995 and August 2001. All patients were evaluated at our institution with VCUG and renal ultrasound. Of 203 patients with normal VCUG ultrasound was abnormal in 32 (16%). Subsequent evaluation demonstrated 1 case each of significant ureteropelvic junction obstruction, ectopic ureter in a bilaterally duplicated system, renal duplication, renal duplication with calculus, ectopic ureter, renal cysts, multicystic dysplastic kidney and renal scarring. In addition, there were 3 cases of ureterovesical obstruction. No significant renal pathology was identified in the other cases. Two of these patients underwent operative intervention. Treatment or parental counseling was altered in 7 others, for a total of 9 of the 203 patients (4.4%). In our population renal ultrasound adds information to the radiographic evaluation of infants after a febrile urinary tract infection. This information alters treatment and parental counseling in a significant number of patients.

Urinary tract infection in men--state of the art.

Urinary tract infections in boys and men are common causes of significant morbidity and, when coupled with urinary tract abnormalities, loss of renal function. Careful and prompt urological assessment is mandatory for proper treatment and prevention of serious and/or chronic sequelae.

The Development of Urology as a Scientific and Clinical Discipline

I T IS A STAGGERING task to attempt to describe development of urology in this space. So many things have happened since end of second World War that this could simply be a list with references to try to help anyone interested in a special topic to find an appropriate source. The best reference to urological history is History of Urology by Leonard J.T. Murphy.' ·' Urology is one of oldest and also one of newest surgical specialties. The Hippocratic Oath interdicts for stone, and suggests it should be left for experts. Fortunately, in these days, cutting for stone is not as common as it used to be. The astonishing development of extracorporeal sound wave lithotripsy changed treatment of urinary calculi immensely. This is probably greatest technical advance in our field . 3 Another classical surgical procedure is still a topic for discussion. Circumcision, which at onc time was widely condemned, is now given respectability as a way to decrease urinary tract infection in boys. The greatest stimulus to urology, as a specialty, occurred with invention of cystoscope. 4 Many years of work led to present superb visualization of urinary tract. One of greatest discoveries was intravenous pyelography by Swick, an American, in early 1930s. , .• Dilatation of prostatic urethra with balloons for benign prostatic hypertrophy (BPH) is under study and currently used.' It is thought to be successful in appropriate cases, but probably not long lasting. In Europe, until after World War II, general surgeons performed most urological surgery. In United States, it became a recognized specialty much earlier and was taught as such. The oldest uTological association in world, American Association of Genito-Urinary Surgeons, was initiated in 1886. Ramon Guiteras founded American Urological Association in 1902, and in 1912 Association declared urology to be a specialty. The International Society of Urology originated in Paris in 1907. The Journal of Urology was introduced in 1917 by Hugh Hampton Young, affectionately known as the father of American urology. 8 The European Association of Urology celebrated its IXth Congress in June 1990. The American Society of University Urologists was organized in 1967. William H. Boyce was first President. Properly, to understand writer's perspective, one should know that when he was in medical school, sulpha drugs, penicillin, and other early antibiotics were first introduced. All other advances mentioned in this report did not exist at that time. Probably introduction of sulpha drugs and antibiotics was single greatest advancement. The concept and development of exiracorporeal lithotripsy is, in my opinion, second greatest contribution. [t is surely greatest technical advancement in urological surgery. 3 Another great surgical advancement eagerly accepted by urology is development of kidney transplantation. This has led to a proliferation of many other types of transplantation, and surely Starzl covers this completely in his report, which is included in this issue. 9 Another tremendous rediscovery in surgical urology has been modern use of intestine as part of urinary tract.1.10 Formerly, Coffey's operation, ureterosigmoidostomy for continent urinary diversion , was only general use of intestine. In past 40 years, intestine has been used in almost every conceivable way. 10 It is used to divert urine to skin, as in Eugene Bricker's operation (uretero-ilio-cutaneous anastomosis). Small intestine is used as a substitute for damaged ureters , and in a number of complicated operations for surgical procedures, to replace and enlarge urinary bladder. ''''' One of greatest achievements in reconstructive urological surgery is reconstruction of urinary space. From 1969 to 1990 these imaginative procedures, after previous diversions, have been reported by W. Hardy Hendren of Boston Children's Hospital. He is a leader in this field. He

Urinary tract infection in boys: K.A. Burbige, A.B. Retik, A.H. Colodny, et al. J Urol 132:541–542, (September), 1984

Urinary tract infection in boys: K.A. Burbige, A.B. Retik, A.H. Colodny, et al. J Urol 132:541–542, (September), 1984

Urinary tract infection in boys: Burbige KA, Retik AB, Colodny AH, et al. J Urol 1984; 132:541–542

Urinary tract infection in boys: Burbige KA, Retik AB, Colodny AH, et al. J Urol 1984; 132:541–542

Self-Induced Urinary Tract Infection in Boys

To the Editor.— It is well recognized that urinary tract infection (UTI) is relatively uncommon in boys after the first months of life. Most authors also agree that, especially in children less than 10 years of age, boys with UTI are more likely than girls to have a urinary tract malformation and a secondary renal damage.1-5 Therefore, radiologic investigation is recommended at a first UTI in boys.6 On the other hand, ureteral instrumentation (like catheterization) can cause UTI in a normal urinary tract.

Urinary Tract Infection in Boys

Considerable literature exists regarding the evaluation and treatment of children with urinary tract infection yet little has been reported solely about boys. We reviewed retrospectively 83 boys who were seen after an initial urinary tract infection. Fever was the most common presenting sign (50 per cent) and the most common organisms encountered were of the gram-positive group of bacteria. Escherichia coli accounted for only 21 per cent of the infections.Of the boys 75 per cent (62 patients) had an anatomic abnormality, most commonly vesicoureteral reflux, although more than 25 per cent of our patients had obstructive lesions. Renal scarring was present in half and 58 per cent required early surgical intervention. Urinary tract infection seems to have a higher morbidity in boys and the finding of an atypical organism is to be expected. Based on our findings, we strongly recommend an excretory urogram and a voiding cystourethrogram as the minimal evaluation of boys following an initial urinary tract infection.