A UTI is a bacterial infection of the Urinary Tract involving the bladder (cystitis) and/or the Kidneys (pyelonephritis). UTI's occur in 3-5% of Girls and 1% of Boys. There are many risk factors for UTI's including the following: female, uncircumcised male, vesiculoureteral reflux (see below), urinary tract abnormalities, voiding dysfunction, bubble baths, constipation, tight clothing, sexual activity, and pregnancy.
We test for a UTI in any child with symptoms including the following: pain with urination, increased frequency of urination, unusual odor to urine, back or lower abdominal pain, or fever without another cause (usually boys under 6-12 months of age and girls under 3 years of age).
Catheterized specimens are the most accurate, followed by a clean catch specimen. Clean catch specimens are usually acceptable for toilet-trained children who are able to cooperate with the collection. Catheterized specimens are used for infants, children not yet toilet trained, and acutely ill patients. Bag specimens are not reliable and therefore are not used regularly to test for a UTI.
If your child's urine culture comes back positive for a UTI they will be placed on an antibiotic that will most appropriately treat the bacteria causing the infection. Usually, children will be placed on a ten-day course of antibiotics. Then after completing antibiotics, we request that they have a repeat urine culture 3 to 4 days later. If the child becomes sicker or symptoms do not seem to improve within 48-72 hours they will need to be re-evaluated.
If your child was diagnosed with a UTI and is a boy at any age, a girl under the age of 6, or an older girl with recurrent UTI's your doctor will discuss the need for further studies.
What further studies may be necessary?
A renal and bladder ultrasound look at the size, shape, and structure of the urinary tract system to identify any structural abnormalities, evidence of scarring, or poor growth of the kidneys.
A Voiding Cystourethrogram (VCUG) checks for vesiculoureteral reflux (VUR). VUR is particularly important because infected urine flows retrograde to the kidneys and can cause kidney scarring and damage. The only way to detect it is through a VCUG. The VCUG involves instilling contrast into the bladder by catheterization and then imaging during bladder filling and voiding to look for the grade reflux. Of children undergoing a VCUG, 40% will have reflux. Approximately 1/3 of siblings of children with reflux have it as well.
Your doctor will discuss the results with you after the tests are done. Usually the results are available within one to two days. If your child has VUR the doctor will discuss prophylactic antibiotics that are taken at bedtime to keep the urine sterile until they outgrow the VUR. Depending on the antibiotic used, a complete blood count may be necessary every 6 months. A repeat VCUG will be necessary each year until they outgrow the VUR. If there are any other abnormalities on the test your doctor will discuss what else, if anything, needs to be done.