Urinary Tract Infection In Girls Research Articles

Longitudinal follow-up of bladder function in children who participated in the Swedish Reflux Trial

Several publications have reported the coexistence of vesicoureteral reflux (VUR) and bladder dysfunction in children. Whether this dysfunction remains in the longer term is not yet known. This study revisited children who participated in the Swedish Reflux Trial (SRT) with the primary aim of evaluating whether bladder and bowel dysfunction (BBD) in these patients persisted until adolescence. The secondary aim was to evaluate two BBD subgroups, and relations to recurrent urinary tract infections (UTI). Of the 161 eligible children at SRT study-end, 73 children participated. Their bladder function was evaluated longitudinally using a validated BBD questionnaire with symptom score (cut-off ≥7) and uroflowmetry, at five (T2) and ten years (T3) after study-end. T1 was the SRT study-end. Besides BBD, the sub-diagnoses overactive bladder (OAB) and dysfunctional voiding symptoms (DVS) were calculated from symptom scores. BBD was diagnosed in 37% of children at mean age 3.7 years, which decreased with age to 23% of adolescents (mean age 15.7). DVS and OAB subgroups were equally common at T1, but only DVS was identified at the last follow-up (T3) (p=0.0008). Recurrent UTIs were seen in 17% at T3 and were more common in patients with BBD (p=0.038). The gender distribution of BBD also changed, from being equally common at the end of the SRT to affecting mainly adolescent girls at the last follow-up (p=0.022). Information was available regarding VUR status after repeat VCUGs during follow-up in 22 patients, 12 of them after endoscopic treatment. An improvement in VUR grade was found in the 22, but during follow-up numbers with BBD or UTI did not differ between treated and non-treated groups. The prevalence of BBD decreased from 37% at 3-4 years of age to 23% in adolescence, when it was almost exclusively seen in girls. BBD and the subgroup DVS were associated with UTI. Even if epidemiological studies have established a predisposition to bladder symptoms and UTI in girls, little is known about bladder function in adolescents with a history of VUR during the first years of life. One limitation of the study was the number of patients participating. Also, the number of patients with kidney damage was more common in the cohort. In this longitudinal follow-up of BBD in children with VUR, the number of children with BBD decreased with age. In adolescence, both BBD and recurrent UTIs mainly affected girls.

Association Between Duration of Constipation and Frequency of Urinary Tract Infection in Children

Background: Constipation and Urinary Tract Infection (UTI) are common problems in children. The gastrointestinal tract and the urinary system are related together anatomically and functionally. Constipation is one of the possible causes of UTI and its recurrence. Objectives: The purpose of this study was to evaluate the association between the duration of constipation and the frequency of upper and lower UTI in children in Sanandaj. Methods: A descriptive-analytical study was performed on children with chronic constipation aged less than 12 years, referring to the Pediatric Gastroenterology Clinic of Besat Hospital in Sanandaj in 2018-2019. Urine analysis and culture were performed for all the patients. Data were recorded in separate questionnaires. Results: There were 220 children in this study. Most cases of constipation and UTI belonged to the group of 3-6 years. Constipation was more common in boys and UTI in girls. Lower UTI was more common than upper UTI. Besides, 45% of the patients had constipation for less than a year. There was no significant relationship between the duration of constipation and the prevalence and type of UTI (upper or lower) (P = 0.405, P = 0.911). Conclusions: Urinary tract infection was common in children with chronic constipation. There was no relationship between the duration of constipation and the frequency and type of UTI.

Recurrent UTIs in Girls: What Is the Role of the Microbiome?

Urinary tract infections (UTIs) are one of the most common childhood bacterial infections. Recurrent UTIs can lead to renal scarring. Compared to boys, girls are more likely to develop scars as a result of recurrent UTIs. Therefore, there is a need to identify girls at high risk for recurrent UTIs and develop interventions to decrease the risk of recurrent UTIs. In this commentary, we will review the hypothesized pathophysiology of recurrent UTIs, explore the literature on the role of the microbiome in recurrent UTIs, focusing on female pediatric patients when able, and highlight the need for future research in this area.

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

Association between vitamin D, antimicrobial peptides and urinary tract infection in infants and young children.

Vitamin D stimulates production of the endogenous antimicrobial peptides cathelicidin and β-defensin-2, which are expressed in the urinary tract. We investigated vitamin D status and levels of cathelicidin and β-defensin-2 and their association with urinary tract infection (UTI). The study included 120 children under three years of age: 76 children with UTIs and 44 otherwise healthy children with congenital hydronephrosis. Serum 25-hydroxycholecalciferol levels were measured by direct competitive electro-chemiluminescence immunoassay, and plasma cathelicidin and β-defensin-2 concentrations were analysed by enzyme-linked immunosorbent assay. We found that vitamin D insufficiency and deficiency are prevalent in young children (21%). Serum vitamin D levels negatively correlated with age and were significantly lower in girls. Levels of vitamin D positively correlated with levels of cathelicidin but not with β-defensin-2. Low concentrations of vitamin D were associated with UTIs in girls, but we did not see any correlation with the recurrence of infection at one-year follow-up. Vitamin D deficiency is common and may prove to be a risk factor for UTIs especially in girls. We hypothesise that adequate supplementation with vitamin D may become a way to prevent first-time UTIs.

Controversies Regarding Management of Vesico-ureteric Reflux.

The primary goal in the management of a child with urinary tract infection (UTI) is to prevent recurrence of UTI and acquired renal damage. Approximately 15% of children develop renal scarring after a first episode of febrile UTI. Vesico-ureteric reflux (VUR) is diagnosed in 30-40% of children imaged after first febrile UTI. The 'top-down' approach involving ultrasound and dimercaptosuccinic acid scan (DMSA) first after an appropriate interval following UTI, can help in avoiding voiding cystourethrogram (VCUG), an invasive test with higher radiation exposure. The majority view remains that VCUG should be done after the second attack of UTI in girls and first attack of UTI in boys. Although the evidence in favour of antibiotic prophylaxis remains doubtful in preventing renal scars associated with VUR, it remains the first line treatment for high-grade reflux (grade 3-5) with an aim to prevent UTI and allow spontaneous resolution of VUR. Early identification and appropriate treatment of associated bowel bladder dysfunction is an essential part of successful medical management of VUR. Endoscopic treatment of VUR, using a bulking agent, is useful in grade 3 VUR. The main controversy regarding intervention (endoscopic/open surgical intervention) involves absence of strong evidence for these interventions in reducing renal scarring on randomized controlled trials. However, several recent trials have found the surgical interventions to be effective in reducing recurrent pyelonephritis and repeated hospital admissions.

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.

Labial adhesion and urinary tract problems: The importance of genital examination

Urinary tract infection (UTI) is a common bacterial illness in children. Delay in the treatment of UTI may lead to acute renal parenchymal damage and subsequent renal scarring. It is well established that several risk factors increase the tendency for UTI - one being labial adhesion (LA). The purpose of this study was to emphasize the importance of genital examination in girls with nephrourologic symptoms, particularly UTIs, in order to detect LA. Data were collected from the files of 46 girls with LA, including: the girl's age, thickness of LA, any recurrence and treatment options of LA, and the reason for admission to hospital. The LAs were grouped in terms of thickness as thin, moderate and dense, and also partial or complete. The average age of the girls at the first visit was 51.9 ± 37.57 months (min-max: 3.5-157 months). Twenty-seven (58.7%) of the girls had history of recurrent UTI. There was a marked association between the presence of UTI and the type of adhesions. The percentages of UTIs in girls with complete and partial LA were 84.0% and 28.6%, respectively (P < 0.05). The percentages of UTIs in girls with thick and thin LA were 100% and 44.1%, respectively (P < 0.05). None of the girls' primary care physicians or pediatricians recognized LA at the time of a periodic health examination. In the present study, girls with complete and thick LA had a greater tendency towards having UTIs than those with partial and thin LA, respectively. After treatment of LA, the UTIs did not recur in any girls. None of the girls in this study had undergone a previous genital examination. Therefore, this study suggests that physicians do not often perform genital examinations. Limitations of this study were the small sample size and the short follow-up period. In addition, although all of the girls were examined by the same physician, the thickness of the membrane is subjective and solely depends on the physician's experience. This study showed that although genital examination is a routine part of a physical examination, it is not always performed. Therefore, it is recommend that genital examination should be performed in girls with nephrourologic complaints, particularly for UTI. By timeously determining the presence of LA, many unnecessary and invasive investigations could be avoided in these children.

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 frequency of urinary tract infection among children with febrile convulsion.

Objective This study was conducted to determine the frequency of urinary tract infection(UTI) among children with febrile convulsion (FC). Materials & Methods We analyzed the hospital records of 137 children who had been admitted to thepediatric ward from March 2004 to February 2007 because of FC. Informationsuch as age, sex, developmental status, type of FC, family history of seizure,urine sampling method, and the results of antibiograms were recorded. Results The age distribution of 137 patients (82 boys, 55 girls) was as follows: 1-6 monthsof age, 1 infant (0.7%); 6-12 months, 21 infants (15.3%); 1-3 years, 75 (54.8%);3-5 years, 30 (21.9%); and more than 5 years, 10 (7.3%). Three out of the 82boys and 6 out of the 55 girls had UTI (3.7% vs. 10.9%, total, 6.6%). The agedistribution of these 9 patients was as follows: 1-6 months, 1 patient (11.1%);7-12 months, 5 (55.6%); and 1-3 years, 3 (33.3%). The relative incidence of UTIwas 6.6%. The most common organisms causing infections were Escherichiacoli in 8 and Proteus spp., in 1 patient (88.8% vs. 11.1%). Simple FC was seenin all 9 patients with UTI. Conclusion In this study, the relative frequency of UTI among children with FC was 6.6%and this frequency was higher that the incidence of UTI in girls and boys(3-5% and 1%, respectively). Therefore, we recommend that UTI should beconsidered as an important cause of FC in children. Keywords: Febrile convulsion; urinary tract infection; children

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.

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.