Tract Infection In Girls Research Articles

The effect of educational intervention program on promoting preventive behaviors of urinary tract infection in girls: a randomized controlled trial

BackgroundUrinary tract infection is one of the most common infectious diseases in children, which can lead to serious complications for a child. The purpose of this study was to investigate the impact of Theory Planned Behavior (TPB) -based education on the promotion of preventive behaviors of urinary tract infection in mothers with a daughter under age two.MethodsThe present study is an educational randomized controlled trial that its sample consisted of 100 mothers who had a daughter under age two. They were selected through convenience sampling and then were randomly assigned to the intervention and control groups (each group included 50 participants). The data collection tool was a reliable and valid questionnaire based on TPB constructs. First, in both groups, the pre-test was administrated and then the educational intervention in the intervention group was conducted in the form of four educational sessions in 1 month (based on the pre-test need assessment) and then 3 months after the intervention (according to the ideas of Panel of Experts), post-test in both groups was administrated and then the data were analyzed through SPSS version 23 software with inferential statistics (independent t-test, paired t-test, and chi-square). The significance level was considered 0.05.ResultsThree months after the intervention, the mean score of the constructs of TPB in the intervention group was significantly higher than the control group. The performance of prevention of urinary tract infection in the intervention group before the education increased from 2.85 ± 0.51 to 3.74 ± 0.29 (out of 4) (p = 0.001).ConclusionsTPB-based education with active and interventional follow-up was effective in promoting the preventive behaviors of urinary tract infection. Therefore, due to the side effects of UTI, especially in vulnerable periods such as childhood, it is recommended that trainings based on this model be carried out in other health care centers in order to maintain children health.Trial registrationThis trial has been registered at IRCT, IRCT2017031533090N1. Registered on 9 July 2017, https://en.irct.ir/trial/25621

Self-Collection of Vaginal Swabs Among Adolescent Girls in a School-Setting in East Africa.

Few studies have evaluated the acceptability of self-collected vaginal swabs among young women in sub-Saharan Africa, including in school settings. We evaluated the acceptability of 2 conditions for the self-collection of swabs in secondary schools in Entebbe, Uganda. Assenting girls with parental consent from 3 secondary schools were provided instructions for sampling, and randomly allocated to self-collection of vaginal swabs with or without nurse assistance to help with correct placement of the swab. Swabs were tested for bacterial vaginosis by Gram stain. Participants were followed up after 1 to 2 days and 1 to 2 weeks and invited for a qualitative interview. Overall 96 girls were enrolled (median age, 16 years; interquartile range, 15-17 years). At the first follow-up visit, participants in both arms reported that instructions for sample collection were easy to understand, and they felt comfortable with self-collection. Girls in the nurse assistance arm reported feeling less relaxed (27% vs. 50%, P = 0.02) than those in the arm without nurse assistance, but more confident that they collected the sample correctly (96% vs. 83%, P = 0.04). About half (47%) of participants agreed that self-sampling was painful, but almost all (94%) would participate in a similar study again. Qualitative data showed that participants preferred self-collection without nurse assistance to preserve privacy. Bacterial vaginosis prevalence was 14% (95% confidence interval, 8-22). In this setting, self-collection of vaginal swabs in secondary schools was acceptable and feasible, and girls preferred self-collection without nurse assistance. Self-collection of swabs is an important tool for the detection, treatment and control of reproductive tract infections in girls and young women.

Detection of urinary lactoferrin as an indicator of urinary tract infection in girls

Background and objective: Lactoferrin (LF) is an iron-binding protein that is related in structure to transferrin. It is considered to be a part of the in­nate immune system. This study aimed to assess the role of urinary lactoferrin (LF) as an indicator for diagnosis of urinary tract infection among girls. Methods: This study was conducted on girls suffering from UTI. Urine samples were tested for Lactoferrin before and after two months of the treatment using ELISA technique. Results: Urine specimens were collected from 25 girls with mean age ± SD of 6 ± 3 years without UTI as a control group (C) and 25 girls with mean age ± SD of 5.3 ± 3.18 years diagnosed as suffering from UTI (T1) followed by a set of 25 specimens after two months (T2). The mean concentration of urinary LF ± SD was 670 ± 319 ng/ml in the specimens of control group whereas it was 1387 ± 509 in the specimens of girls with UTI during the infection (T1) and 885 ± 268 after two months (T2). The mean concentrations of urinary LF during the infection (T1) were significantly (P <0.001) increased compared with controls (C) and significantly (P = 0.003) decreased after two months (T2), that may refer to a role of urinary LF in UTI. There was no significant (P = 0.089) difference between the mean concentration of urinary LF after two months (T2) compared with controls (C) that may indicate to the normalization of LF concentration after the treatment synchronously with disappearing of UTI symptoms and significantly reduction of positive urinalysis results. Conclusion: The results of this study indicate the elevation of urinary Lactoferrin (LF) in girls suffering from UTI and probably being a good indicator for diagnosis of UTI.

Urinating in the Standing Position: A Feasible Alternative for Elderly Women With Knee Osteoarthritis

Urinating while standing is a possible alternative for elderly women with knee osteoarthritis when a sitting toilet is unavailable. We evaluated uroflowmetric characteristics and post-void residual urine volume in elderly women with knee osteoarthritis who urinated while standing. We recruited 21 women with a mean±SD age of 65.0±4.6 years who had a knee osteoarthritis Lequesne index score of at least 6 points and were unable to maintain or found it difficult to stand up from a squat or crouch. Participants used a homemade auxiliary appliance to collect urine and drain it forward while stand voiding. Uroflowmetric data, including voided volume, and maximal and average flow rates, were recorded. Post-void residual urine volume was detected using an ultrasound bladder scanner. Participants completed a questionnaire to evaluate their attitude toward stand voiding and using the auxiliary device. Maximal and average flow rates, and voided and post-void residual urine volumes were not statistically different while sitting and standing. No learning curve was noted for stand voiding. Uroflowmetry patterns while standing were smooth. Of the 21 participants 17 (81%) experienced no difficulty while stand voiding. All expressed willingness to urinate while standing position if they did not have access to a satisfactorily clean toilet seat. Urinating while standing is a feasible option for elderly women with knee osteoarthritis who have difficulty crouching or squatting to void in public restrooms.

The swedish reflux trial in children. iii. pattern of urinary tract infections

Purpose To evaluate the difference in rate of febrile urinary tract infection in small children with dilating vesicoureteral reflux, randomly allocated to 3 management alternatives: antibiotic prophylaxis, endoscopic treament, or surveillance only (control group). Material and Methods From 23 centers, a total of 203 children were included, 128 girls and 75 boys aged 1 to less than 2 years. Vesicoureteral reflux grade III (n=126) or IV (n=77) was detected after a febrile urinary tract infection in 194 and after antenatal screening in 9. Voiding cystourethrography and dimercaptosuccinic acid scintigraphy were performed before randomization and after 2 years. The rate of symptomatic febrile urinary tract infections was analyzed according to the intention-to-treat principle. Results There were 67 febrile recurrences in 42 girls and 8 recurrences in 7 boys (p=0.0001). There was a difference in recurrence rate between the treatment groups in girls, were febrile infection was seen in 8 of 43 (19%) girls in the prophylaxis, 10 of 43 (23%) in the endoscopic, and 24 of 42 (57%) in the surveillance group (p=0.0002). In girls there was no difference in recurrence rate between those with grade III and IV reflux at entry, but recurrence was associated with reflux grade at follow-up (p=0.0095). Conclusions In this randomized controlled trial there was a high rate of recurrent febrile urinary tract infections in girls over the age of 1 year with dilating vesicoureteral reflux, but not in boys. Both antibiotic prophylaxis and endoscopic treatment reduced the rate of infections.

Do uroflowmetric findings change by treatment of urinary tract infection in girls with dysfunctional voiding?

The goal of the study was to evaluate the efficiency of repeated uroflowmetry study in girls who present with dysfunctional voiding with normal radiologic evaluation. Materials and methods: Twenty five children (25 girls with a mean age of 8.9 years) with recurrent urinary tract infection (UTI) and dysfunctional voiding who have normal radiologic evaluation were prospectively evaluated by uroflowmetry tests. Uroflowmetry study was repeated after the UTI treatment in asymptomatic period. Results: Mean urine volume was 254.31 ± 199.49 cc and the mean micturition time was 25.22 ± 15.43 s at the first uroflowmetry. Prolonged micturition time was noted in 8 (32%) patients. At the second uroflowmetry, mean urine volume was 370.77 ± 217.89 cc, and the mean micturition time was 29.63 ± 26.42 s. Prolonged micturition time was noted in 7 (28%) patients. Flow pattern curve was bell-shaped in 9 patients and abnormal in 16 patients (64%). In the second investigation a normal flow pattern curve was noted in 10 patients and an abnormal pattern in 15 patients. Conclusion: There was no difference between pre- and post-treatment uroflowmetry pattern in patients with dysfunctional voiding. Uroflowmetry investigation is not a very proper way for follow-up.

Correlates of Mucosal Immunity and Upper Respiratory Tract Infections in Girls

In this study we examined whether salivary hormones, physical activity and adiposity were correlated with secretory immunoglobulin A (sIgA) and frequency of upper respiratory tract infections (URTI) in 43 early-pubertal and 59 late-pubertal girls. Physical activity was measured using accelerometers and relative body fat was assessed using bioelectrical impendence. Resting saliva samples were obtained between 1500 and 1800 hr and assayed for sIgA, cortisol and testosterone. Participants completed a one-month health log to record URTI frequency. Early-pubertal girls were more physically active, had less adiposity, but lower concentrations of sIgA than late-pubertal adolescents (122.7 +/- 91.6 vs 201.9 +/- 102.9 pg/ml, respectively). The frequency of URTI was similar in the two groups. Neither sIgA nor URTI were correlated with salivary hormones, physical activity or adiposity within the early-pubertal girls. In the late-pubertal group, sIgA was negatively associated (r = -0.44; p < 0.05) with cortisol, and positively associated (r = 0.41; p < 0.05) with the testosterone to cortisol ratio. These results suggest that mucosal immunity increases with pubertal maturation, while higher cortisol is associated with lower mucosal immunity in adolescents.

The Relevance of Urodynamic Studies for Urge Syndrome and Dysfunctional Voiding: A Multicenter Controlled Trial in Children

The objective of this study was to compare prospectively, in urge syndrome and dysfunctional voiding, clinical patterns with urodynamic patterns, to assess changes in urodynamic patterns after treatment, and to correlate urodynamic patterns and parameters with treatment outcome. In the European Bladder Dysfunction Study 97 children with clinically diagnosed urge syndrome received standard treatment, to which was randomly added placebo, oxybutynin or bladder training with online feedback. In a separate branch 105 children with clinically diagnosed dysfunctional voiding were randomly allocated to standard treatment or standard treatment plus pelvic floor training with online feedback. In all children urodynamic studies were performed before and immediately after treatment. In urge syndrome detrusor overactivity was present in 33% of cases before and 27% after treatment (of which 65% were de novo). Detrusor overactivity did not correlate with treatment outcome. In dysfunctional voiding increased pelvic floor activity during voiding, which was present in 67% of cases before and 56% after treatment (of which 45% were de novo), did not correlate with treatment outcome. In urge syndrome as well as in dysfunctional voiding neither maximum detrusor pressure during voiding, cystometric bladder capacity, bladder compliance nor free flow patterns correlated with treatment outcome. Neither detrusor overactivity nor increased pelvic floor activity during voiding correlated with treatment outcome. Standard treatment could be the first choice in urge syndrome as well as in dysfunctional voiding, reserving urodynamic studies for patients in whom this first approach fails.

THE TREATMENT OF POST-URETHROTOMY INCONTINENCE IN PEDIATRIC AND ADOLESCENT FEMALES

No AccessJournal of UrologyPEDIATRIC UROLOGY1 Mar 2001THE TREATMENT OF POST-URETHROTOMY INCONTINENCE IN PEDIATRIC AND ADOLESCENT FEMALES TOM P. V.M. de JONG, JAN D. VAN GOOL, PIETER DIK, AART J. KLIJN, and MARIANNE A.W. VIJVERBERG TOM P. V.M. de JONGTOM P. V.M. de JONG More articles by this author , JAN D. VAN GOOLJAN D. VAN GOOL More articles by this author , PIETER DIKPIETER DIK More articles by this author , AART J. KLIJNAART J. KLIJN More articles by this author , and MARIANNE A.W. VIJVERBERGMARIANNE A.W. VIJVERBERG More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)66577-9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Until 1986 many urologists performed currently outdated, redundant internal urethrotomy as standard therapy for recurrent urinary tract infection in girls. We describe the results of therapy in patients who became incontinent due to previous internal urethrotomy. Materials and Methods: Between 1986 and 1995, 21 female patients with post-Otis urethrotomy incontinence have presented at our department with combined dysfunctional voiding, recurrent urinary tract infection and various types of urinary incontinence partially based on bladder instability and often provoked by abdominal straining. All cases were diagnosed by repeat video urodynamics and ultrasound of the open bladder neck. Endoscopy provided proof of scarring in the bladder neck and urethra. All patients except 1 underwent conservative treatment for at least 2 years, consisting of pharmacological therapy, physical therapy and biofeedback training. Surgical therapy to cure incontinence was performed in 14 cases, including a conventional Burch-type colposuspension in 5, modified needle colposuspension in 4 and complete endoscopic excision of the urethral scars followed by open reconstruction of the bladder neck and urethra in an abdominoperineal procedure in 5. Results: Conservative treatment has been completely successful in 7 patients. Primary open or needle colposuspension was unsuccessful in 6 of 9 cases, including several requiring further surgery to achieve dryness. The results of excising urethral scars with bladder neck and urethral reconstruction were good in 4 of 5 patients at a followup of at least 4 years. Conclusions: When previous internal urethrotomy appears to be an important factor in the evaluation of incontinence, conservative therapy is the treatment of choice. Conservative therapy should consist of biofeedback reeducation of the voiding pattern and physical therapy. When surgery is needed, excision of the urethral scars with reconstruction of the bladder neck and urethra plus colposuspension is superior to colposuspension only. References 1 : Internal urethrotomy and recurrent urinary tract infection in female children. I. Results in the management of infection. J Urol1968; 100: 297. Link, Google Scholar 2 : Bladder neck obstruction in children. J Urol1963; 89: 384. Link, Google Scholar 3 : A blind comparison of dilatation, urethrotomy and medication alone in the treatment of urinary tract infection in girls. J Urol1973; 109: 917. Link, Google Scholar 4 : Internal urethrotomy in girls and its impact on the urethral intrinsic and extrinsic continence mechanisms. J Urol1986; 136: 1248. Link, Google Scholar 5 : Internal urethrotomy in female subjects. J Urol1986; 136: 1280. Link, Google Scholar 6 : Bladder neck reconstruction for total urinary incontinence: 10 years experience. J Urol1981; 125: 321. Link, Google Scholar 7 : Construction of female urethra from vaginal wall and a perineal flap. J Urol1980; 123: 657. Google Scholar 8 : Bladder rehabilitation: the effect of a cognitive training program on urge incontinence. Eur Urol1997; 31: 68. Google Scholar 9 : Outpatient pelvic floor therapy in girls with daytime incontinence and dysfunctional voiding. Urology1996; 48: 923. Google Scholar 10 : Standardisation and definitions in lower urinary tract dysfunction in children. Br J Urol1998; 81: 1. Google Scholar From the Pediatric Renal Center, University Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands© 2001 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 165Issue 3March 2001Page: 929-933 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.Keywordsurinary incontinenceurethracicatrixurinary tract infectionsiatrogenic diseaseMetricsAuthor Information TOM P. V.M. de JONG More articles by this author JAN D. VAN GOOL More articles by this author PIETER DIK More articles by this author AART J. KLIJN More articles by this author MARIANNE A.W. VIJVERBERG More articles by this author Expand All Advertisement PDF downloadLoading ...

The treatment of post-urethrotomy incontinence in pediatric and adolescent females.

Until 1986 many urologists performed currently outdated, redundant internal urethrotomy as standard therapy for recurrent urinary tract infection in girls. We describe the results of therapy in patients who became incontinent due to previous internal urethrotomy. Between 1986 and 1995, 21 female patients with post-Otis urethrotomy incontinence have presented at our department with combined dysfunctional voiding, recurrent urinary tract infection and various types of urinary incontinence partially based on bladder instability and often provoked by abdominal straining. All cases were diagnosed by repeat video urodynamics and ultrasound of the open bladder neck. Endoscopy provided proof of scarring in the bladder neck and urethra. All patients except 1 underwent conservative treatment for at least 2 years, consisting of pharmacological therapy, physical therapy and biofeedback training. Surgical therapy to cure incontinence was performed in 14 cases, including a conventional Burch-type colposuspension in 5, modified needle colposuspension in 4 and complete endoscopic excision of the urethral scars followed by open reconstruction of the bladder neck and urethra in an abdominoperineal procedure in 5. Conservative treatment has been completely successful in 7 patients. Primary open or needle colposuspension was unsuccessful in 6 of 9 cases, including several requiring further surgery to achieve dryness. The results of excising urethral scars with bladder neck and urethral reconstruction were good in 4 of 5 patients at a followup of at least 4 years. When previous internal urethrotomy appears to be an important factor in the evaluation of incontinence, conservative therapy is the treatment of choice. Conservative therapy should consist of biofeedback reeducation of the voiding pattern and physical therapy. When surgery is needed, excision of the urethral scars with reconstruction of the bladder neck and urethra plus colposuspension is superior to colposuspension only.

THE DYSFUNCTIONAL VOIDING SCORING SYSTEM: QUANTITATIVE STANDARDIZATION OF DYSFUNCTIONAL VOIDING SYMPTOMS IN CHILDREN

THE DYSFUNCTIONAL VOIDING SCORING SYSTEM: QUANTITATIVE STANDARDIZATION OF DYSFUNCTIONAL VOIDING SYMPTOMS IN CHILDREN

Urinary Tract Infections in Girls: The Cost Effectiveness of Currently Recommended Investigative Routines

Urinary Tract Infections in Girls: The Cost Effectiveness of Currently Recommended Investigative Routines

Urinary tract infection, day wetting and other voiding symptoms in seven‐to eight‐year‐old Danish children

In this cross-sectional epidemiological questionnaire survey of 7-8-y-old Danish school entrants with focus on voiding habits, 29% were found to have symptoms that could suggest that bladder control was not fully developed. The frequency of day wetting, urgency, emptying difficulties, nocturnal enuresis, nocturia and encopresis, and the median frequency of voidings are presented. Furthermore, the relationship between urinary tract infections, day wetting, encopresis and voiding habits is investigated. There was an association between previous urinary tract infection in girls and current voiding symptoms, suggesting bladder dysfunction as a predisposing factor to infections. In particular, focus should be placed on girls with squatting on urge and/or emptying difficulties.

Urinary tract infections in girls: the cost-effectiveness of currently recommended investigative routines

Current recommendations for the universal investigation of urinary tract infection (UTI) in children by ultrasonography, voiding cystourethrography, and dimercaptosuccinic acid renal scan (and sometimes intravenous pyelography as well) are not based on any convincing evidence as to the necessity or effectiveness of such a routine. Over 8% of all girls will have a UTI during childhood. About 87 individuals in a million will develop end-stage renal disease (ESRD) by the age of 60 years, caused in about 9% by pyelonephritis (PN) or reflux nephropathy. From these statistics, the maximal risk of a first diagnosed UTI progressing to ESRD is approximately 1:10,000. The risk of developing hypertension following a first UTI in childhood, without eventual evolution to ESRD, appears to be very small. The cost of the widely recommended routine imaging procedures ranges from U.S. $355 in Britain to U.S. $1,090 in the United States. The minimal cost of preventing a single progression to ESRD by early diagnosis of underlying pathology-if this were possible in all cases-would range between U.S. $5 million in Britain and U.S. $15 million in the United States. Since in many instances progressive renal damage can not be prevented, the true cost is considerably higher. Lower UTI in girls is a very common and, in most cases, benign finding in primary-care practice. It is suggested that girls with afebrile UTI, presenting with lower urinary tract symptoms alone, need not undergo any imaging procedures, but should be followed with urine examinations and cultures at the time of febrile illness. The recommended investigative routines should be reserved for UTI in infants and in girls with fever or other symptoms suggesting PN, and for proven recurrent UTI. Such a regimen will allow a marked saving in terms of costs and in terms of unnecessary radiation, psychological stress to children, and stress, inconvenience, and time loss to parents. There is no evidence that this approach will compromise the course or final outcome of this very common condition.

Short-term treatment of acute urinary tract infection in girls

The efficiency of treatment of acute urinary tract infections with sulfamethizole for 3 days, sulfamethizole for 10 days, and pivmecillinam for 3 days was compared in a randomized multicentre study comprising 264 girls aged 1-15 years. For ethical reasons children with complicated diseases were not included. In these treatment groups no significant growth after treatment was found in 81%, 77%, and 74%, respectively (NS). New bacteria after treatment were found less frequently after sulfamethizole for 3 days (4%) when compared to sulfamethizole for 10 days (14%) and pivmecillinam for 3 days (13%) (p = 0.048). After pivmecillinam treatment 75% of new bacteria were Streptococcus faecalis versus 25% after sulfamethizole for 3 days and 18% after sulfamethizole for 10 days (p = 0.016). In the subgroup with nephro-urological abnormalities no significant growth after treatment was found in 68% of the sulfamethizole 3-day treated group, 54% of the sulfamethizole 10-day treated group, and 67% of the pivmecillinam 3-day treated group (NS). All treatments resulted in a change in the bacterial sensitivity pattern when bacteria isolated 1-10 days after treatment was compared to those found before treatment. This was more pronounced after the 10-day treatment when compared to the 3-day treatment. The sensitivity patterns of the bacteria isolated from recurrences were similar to those seen before treatment. After treatment there was no difference in the actuarial percentage recurrence-free curves of the 3 treatment groups. Side effects were rare in the sulfamethizole treated groups, and seen more often in the pivmecillinam treated group. 3-day treatment with sulfamethizole or alternatively pivmecillinam is recommended as first choice for treatment of uncomplicated acute urinary tract infections in girls.

URINARY LDH IN URINARY TRACT INFECTIDNS

Three published reports show increased activity of the slow moving LDH isoenzymes in the urine of children with upper urinary tract infections. We studied urinary LDH enzyme activity during 88 urinary tract infections in girls in whom the site of infection was localized using the bladder washout test (BWO).These data do not distinguish patients with upper tract from those with lower tract infections. We also compared urinary LDH activity in girls with BWO confirmed clinical cystitis with those with BWO confirmed clinical pyelonephritis.There were no significant differences in LDH activity between these two groups of patients.

Single-dose amikacin treatment of first childhood E. coli lower urinary tract infections

Urinary tract infection in children is usually treated with orally administered antibiotics for 10 to 14 days. Because of the unreliability of patient compliance with prescribed medications and because single-dose aminoglycoside therapy has been shown to be effective in women with cystitis, we assessed the efficacy of single-dose amikacin for treatment of first episodes of Escherichia coli lower urinary tract infection in girls. Upper and lower urinary tract infections were presumptively differentiated by simple criteria such as clinical symptoms, fever, and erythrocyte sedimentation rate. Fifty-four girls (ages 1 to 12 years) with two positive urine cultures (greater than 10(5) CFU/ml E. coli) were assigned by a table of random numbers to receive treatment with either sulfisoxazole 150 mg/kg/day orally for 10 days or a single dose of amikacin 7.5 mg/kg intramuscularly. Six of 23 patients (26%) in the amikacin group and four of 21 (19%) in the sulfisoxazole group had at least one positive urine culture within 40 days after completion of therapy. This difference was not statistically significant (P greater than 0.5). This suggests that a single dose of amikacin is as effective as a 10-day course of sulfisoxazole in the treatment of presumed first lower urinary tract infection in girls. Additional potential advantages of single-dose therapy are fewer side effects and less toxicity, excellent compliance, and reduced potential for selecting resistant organisms.

Serum C-reactive protein and the site of urinary tract infections

Elevated surum levels of C-reactive protein have been found regularly in girls with acute clinical pyelonephritis but only infrequently in those with clinical cystitis. Based on these data, the suggestion has been made that elevated serum CRP concentrations may be useful in identifying patients with upper urinary tract infections. In a study in which the bladder washout test was used to localize the site of urinary tract infections, we identified nine girls with renal bacteriuria who did not have clinical findings suggesting acute pyelonephritis; four of these girls had serum CRP concentrations less than 10 micrograms/ml. Twenty-eight girls had bladder washout-proven lower urinary tract infections; three of these had serum CRP values greater than 30 micrograms/ml. These studies show that an elevated serum CRP concentration is not accurate in localizing the site of a urinary tract infection in girls who do not have clinical signs of acute pyelonephritis.

Autoantibodies to Tamm-Horsfall protein associated with urinary tract infections in girls

Girls with various forms of urinary tract infections and a reference material were analyzed for autoantibodies in serum to the Tamm-Horsfall glycoprotein. Such antibodies could be detected in all sera analyzed. In the control subjects cord blood contained very low IgA and IgM anti-TH, which increased significantly up to the age of 8 months. The IgG anti-TH levels in cord blood correlated with maternal levels. After the age of 2 months the IgG anti-TH followed the anti-TH levels of the other immunoglobulin classes. Among the infants aged 2 to 7 months with acute UTI, no anti-TH increases were found. In girls more than one year of age with acute nonobstructive UTI, IgG and IgA anti-TH levels were significantly higher in those with acute pyelonephritis and reflux, with or without parenchymal reduction, than in those with acute pyelonephritis and normal radiologic findings. The latter group had significantly higher levels of IgG and IgA but not IgM anti-TH than did those with acute cystitits. In contrast, girls with renal parenchymal reduction but no signs of infection at the time of testing had significantly depressed anti-TH levels compared to control values.

LONG‐TERM PROPHYLAXIS WITH METHENAMINE HIPPURATE IN GIRLS WITH RECURRENT URINARY TRACT INFECTIONS

Twenty girls, aged 5-12 years, with recurrent urinary tract infections, were treated with methenamine hippurate, Hiprex, for a period of 12 months. The number of infections per patient per year was reduced from 3.1 to 0.7 (p less than 0.001). After prophylaxis was stopped this number increased to 1.4 which is a significantly higher incidence than occurred during treatment (p less than 0.05). A few girls complained of the taste but no side-effects were observed. Methenamine hippurate is a useful alternative in long-term prophylaxis against recurrent urinary tract infections in girls.