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Common Ut Concerns In Children
- 1. COMMON URINARY TRACT CONCERNS IN CHILDREN Waldo C. Feng M.D.,Ph.D. Children’s Urology Associates Las Vegas, Nevada
- 4. UTI Incidence Kunin, 1998
- 19. UTI Management Controversy Looms
- 45. THE END?
Editor's Notes
- Probably one of the most controversial topics among urologist. Who to treat and how to treat.
- This is the effect of foreskin. Children are beginning to potty-train- dysfunctional voiding.
- Unlike adults, we have to more perceptive about symptoms. Do not present with dysuria, supra pubic pain. Hematuria on dipstick. Children present diferently at different ages.
- UTI is a generic term. We try to localize the infection to determine our course of investigation with imaging, and treatment. Bladder infections are low grade temperature, goes down with tynelol.
- High grade temperature.
- Other routes hematogenous, lymphatic but the most common is ascending route. Why girls are more at risk than boys,
- E. Coli most common organism. Over 150 strains, fewer than 10 account for the majority of the cases. It relates to the virulence factor. 91% E.coli causing pyelo have the fimbriae.
- Breast feeding have some protective effect. Most important easiest to perform is good voiding habits. Do not ask the child when to void, put on a schedule. Fast flowing river clear versus a stagnant pool. Doubling time every 40 minutes.
- So who are at risk for UTI’s. Reflux, PUV, duplicated ureters. Immunocompromise, neurogenic bladder.
- Look for some clues in the history and physical.
- Most common are gram negative enteric bacteria.
- The goals of treatment is two fold. Certainly early detection, imaging have dramatically reduced the long-term sequelae.
- Widespread use of DMSA technetium 99 dimercaptosuccinic acid with febrile uti’s up to 50% 2 to 2 years later show scarring. Next slide an example of DMSA.
- Any photopenic areas are scarred, non functioning nephrons. What are the chances of renal scarring?
- What to look on a office dipstick since few places do direct microscopic analysis.
- Bagged is good a ruling out a UTI, not useful in documenting one. SP is the gold standard.
- Suggest you have an infection.
- Once we have made a diagnosis of UTI-