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Recurrent Urinary Tract Infections and Related Conditions
Urinary tract infections (UTIs) are common in kids, especially girls and uncircumcised boys. In fact, by age 5, about 8% of girls and 1%-2% of boys have had at least one UTI. UTIs occur when the kidneys, ureters, bladder, or urethra become infected.
Symptoms of a UTI can include:
UTIs can also cause kids to wet their pants or the bed, even if they haven't had these problems before. Infants and young children may only show nonspecific signs such as fever, vomiting, or decreased appetite or activity.
Some kids experience UTIs again and again — these are called recurrent UTIs. If left untreated, recurrent UTIs can cause kidney damage, especially in kids younger than 6. So it's important to know how to recognize the signs of these infections and get help for your child.
Types of UTIs
Common types of UTIs include:
Recurrent UTIs sometimes happen in conjunction with other conditions, such as:
But not all cases of recurrent UTIs can be traced back to these body structure-related abnormalities. For example, dysfunctional voiding — when a child doesn't relax the muscles properly while urinating — is a common cause of UTIs. Infrequent urination - not peeing often enough - can also increase a child's risk of developing recurrent infections. Both dysfunctional voiding and infrequent urination are associated with constipation.
Unrelated conditions that compromise the body's natural defenses, such as diseases of the immune system, can also lead to recurrent UTIs, although this is rare. In addition, using a nonsterile urinary catheter can introduce bacteria into the urinary tract and cause an infection.
Although UTIs can be treated with antibiotics, it's important for a doctor to rule out any underlying abnormalities in the urinary system when these infections occur repeatedly. Kids with recurrent infections should see a pediatric urologist to determine what is causing the infections.
Some abnormalities can be detected even before birth. Hydronephrosis, when it occurs as a congenital condition, can be detected in a fetus by ultrasound as early as 16 weeks of gestation. In rare cases, doctors may consider neonatal surgery (performing surgery on an unborn baby) if hydronephrosis affects both kidneys and poses a risk to the developing fetus. Most of the time, though, doctors wait until after birth to treat the condition, because almost half of all cases that are diagnosed prenatally disappear by the time a baby is born.
Once a baby suspected to have hydronephrosis or another urinary system abnormality is born, the baby's blood pressure will be monitored carefully, because some kidney abnormalities can cause high blood pressure. An ultrasound may be used again to get a closer look at the bladder and kidneys. If the condition appears to be affecting both kidneys, doctors will usually order blood tests to measure kidney function.
If an abnormality of the urinary tract is suspected, doctors might order tests to make an accurate diagnosis, including:
When an ultrasound points to VUR or hydronephrosis, a renal scan or voiding cystourethrogram (VCUG) might give doctors a better idea of what's going on.
Renal scan (nuclear scan)
Voiding cystourethrogram (VCUG or cystogram)
Magnetic resonance urography (MR-U)
Treatment for recurrent UTIs depends on what's causing them in the first place. Sometimes the answer is as simple as teaching a child to empty the bladder as soon as he or she has the urge to go.
If a condition like VUR is causing the infections, then the solution is a bit more complicated. Kids with VUR must be monitored closely, because the condition can lead to kidney infection (pyelonephritis) and subsequent kidney damage. Usually, surgery isn't necessary, because many kids outgrow the condition.
Some kids with VUR benefit from daily treatment with a small amount of antibiotics, which can also make surgery unnecessary. Kids with VUR should be examined by a pediatric urologist to decide if antibiotic treatment is the best option for them.
In some cases, surgery is necessary to correct VUR. The most common type of surgery in these situations is ureteral reimplantation, in which one or both ureters are extended further into the bladder to correct the backflow of urine from the bladder to the ureters and kidneys. The success rate for this type of procedure is high, although not everyone is a good candidate for surgery.
Kids with the following situations may be candidates for ureteral reimplantation:
An alternative to ureteral reimplantation is endoscopic injection of a material to block the entry of the ureter into the bladder and prevent VUR. In this procedure, a narrow tube called an endoscope is inserted through the urethra into the bladder. The endoscope has a tiny camera at the tip, allowing the surgeon to guide it to the proper location and inject the material, which helps keep urine from refluxing back into the kidneys. Endoscopic injection is less invasive than open surgery, but the results are not as good. A pediatric urologist can help families decide the best treatment for a child with VUR.
Kids who have recurrent infections that are not caused by anatomical defects or other treatable problems may be prescribed antibiotics for months or even years to prevent recurrent infections. This form of treatment is known as continuous antibiotic prophylaxis.
The Future for Managing Recurrent UTIs
Recent studies have found that women and kids who get recurrent UTIs may lack certain immunoglobins (a group of proteins that fight infections). Some researchers are optimistic that a vaccine may be developed to help boost production of antibodies that fight UTIs. A promising vaccine that would protect against E. coli (the most common bacterium that causes UTIs) is being tested.
Additional things to consider to help prevent recurrent UTIs in kids:
Good Bathroom Habits
No Bubble Baths
Frequent Diaper Changes
Proper Wiping Technique
Frequent Bathroom Visits
When to Call the Doctor
As soon as you suspect a UTI in your child, it's important to contact your doctor. The doctor may recommend another urine culture after treatment of a UTI is completed to be sure that the infection has cleared.
If your child suffers from recurrent UTIs, consult a pediatric urologist, who can perform a thorough evaluation and, if necessary, order tests for urinary system abnormalities. In the meantime, follow your doctor's instructions for treating a UTI.
Reviewed by: T. Ernesto Figueroa, MD