Pediatric urinary tract infections
afflict 3% of all children in the United States each year with girls suffering more commonly than boys. In very rare cases, the condition is chronic and can debilitate child development. In the rare case of chronic urinary tract infections, also known as UTI, the pediatrician may test the child for a condition known as vesicoureteral reflux. Understanding the cause and origin of vesicoureteral reflux, in addition to the prevention, diagnosis and treatment, will foster a more healthy child growth and development process.
During normal urine elimination, the bladder contracts and urine travels to the urethra and is expelled from the body. In urinary tract disorders, a sort of reflux action may occur resulting in a process by which the urine travels back into the ureter during urination. Because the normal urination process allows urine to pass from the kidneys, into the bladder and then into the ureter for discharge, the reflux condition causes the urine in the bladder or ureter, to revert and travel back into the kidneys resulting in a urinary tract infection. When this reflux motion is chronic, and the pediatric patient repeatedly suffers from UTI, this could be an indicator of pediatric onset of vesicoureteral reflux. With a genetic component, vesicoureteral reflux is common among siblings with a 33% change a sibling will suffer from the same condition.
Diagnosing pediatric vesicoureteral reflux is done by the pediatrician in patients with prolonged, frequent and chronic urinary tract infections. Testing involves a nuclear cystogram which is described as a process by which a catheter is placed into the ureter, dye injected into the bladder and observation is made during urination process. During testing, If dye is observed flowing back into the kidneys, a positive diagnosis of pediatric vesicoureteral reflux is made. Today, pediatric urologists perform this cystogram quite frequently as it has been determined that chronic urinary tract infections, caused by pediatric vesicoureteral reflux, can lead to renal scarring and permanent kidney damage. Early diagnosing is key in treating and preventing chronic and long term health implications.
When positively diagnosed with pediatric vesicoureteral reflux, the pediatric urologist may choose to take a conservative approach providing little treatment other than frequent monitoring of the kidney activities. Under this treatment approach, the school of thought leans towards self cure or self healing process in which the reflux condition dissipates, as the child ages, without medical intervention. A “grade” is applied to the reflux condition upon positive diagnosing, and ranges from 1 to 5, with the higher grade level less likely to self heal. In those cases, surgery may be required and, fortunately, is found to be 95% successful with pediatric hospital admission only required for one to two days. The disadvantage to surgery, is the bikini line scar left in the abdominal area of the pediatric patient.
To prevent urinary tract infections, in children with vesicoureteral reflux, the pediatric urologist will most likely place the child on prophylactic antiobiotics, given in very low doses, once or twice daily. Additionally, parents are counseled to closely monitor the urinary elimination and bowel movements of the children as constipation tends to increase the incidence of infection and is common in children suffering from pediatric vesicoureteral reflux. Additionally, urination symptoms of burning, frequency, urgency, straining, foul odor and blood are all signs of a urinary tract infection.
In summary, pediatric urinary tract infections, while painful, should not be simply treated and resolved as a single episode.
In cases of chronic and ongoing UTI, consult your pediatrician regarding a pediatric cystogram as a preventative measure in confirming the existance, or non-existance, of a urinary reflux disorder. When positively diagnosed, pediatric patients should follow a strict monitoring program which includes antibiotic usage and frequent monitoring of kidney function to as to ensure an negative impact to the pediatric kidney including renal dysfunction and scarring.