Urinary Tract Infection

by

Richard M. Parker, M.D.

If your child has a urinary tract infection...bacteria that are usually outside the body have entered the urethra, bladder, and sometimes the kidneys (the urinary tract). These germs have obtained a foothold and multiplied, often causing discomfort with urination.

Anyone can get an infection...including newborn babies, children, and adults. During the first year of life and especially the first three months, infections are more common in boys than girls. Thereafter, urinary infections are more common in girls. Many children have repeated infections and it is important to look for kidney or bladder abnormalities causing these infections.

Some children are predisposed to infection... The vaginal area in some female infants and children allow bacteria normally in the lower bowel or rectum to attach strongly (adhere), multiply, and then enter the urinary tract. Poor immunity due to deficient antibodies within the bladder or bladder lining may contribute to frequent infections. Genetic factors including some blood types seem to predispose to infections as does the foreskin of uncircumcised male infants.

In addition, these abnormalities may contribute to urinary infections:

  1. Difficult urination and poor emptying of the bladder.
  2. "Dysfunctional voiding" with daytime urgency and incontinence, squatting and increased bladder voiding pressures with or without infrequent voiding
  3. Chronic constipation
  4. Blockage to the kidneys or bladder.
  5. Reflux, a congenital condition in which urine backs up from the bladder and goes into the ureters and kidneys.

The symptoms of an infections are...

The presence of a high fever and infection is of special concern, as this usually indicates a kidney infection.

To diagnose an infection...we look at a urine specimen under a microscope for the presence of bacteria and white blood cells (pus cells). The best way to diagnose an infection is to grow the bacteria in a urine culture in the laboratory. Urine for the culture can be obtained in one of three ways:

  1. Placing a bag over the penis or vaginal area...
  2. Placing a needle into the bladder from the lower abdomen (suprapubic aspiration)...
  3. Placing a rubber tube into the urethra and bladder (catheterization).

Urinary tract infections should be treated quickly with antibiotics... Some children need treatment with antibiotics for many months to prevent these infections and must be checked frequently for recurrences. They may outgrow these infections with time and with special voiding instruction and training.

Usually studies of the kidneys and bladder are necessary to check for abnormalities such as a thickened bladder, urinary obstruction or vesicoureteral reflux which can cause an infection. These are quick outpatient studies and usually include ultrasound examination of the kidneys and x-ray studies of the bladder (a voiding cystogram). Some kidney and bladder abnormalities will improve with time and some may need surgical correction.

If infections are not adequately treated, there is a danger of repeated illness, kidney scarring, loss of kidney function, high blood pressure, and kidney failure. Fortunately these extreme conditions occur infrequently.

This discussion serves as an introduction to the problem of urinary tract infections. I encourage you to discuss your concerns and questions about the treatment of your child's condition with me.

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Richard M. Parker, M.D., F.A.A.P., F.A.C.S.
Parker@PedsUroLogic.com

Arnold Medical Pavilion
1221 Madison Street
Suite 412
Seattle, WA 98104 USA

Phone: (206) 682-2216
Fax: (206) 682-6058

The Olympic Center
1310 116th Avenue N.E.
Suite B
Bellevue, WA 98004 USA

Phone: (206) 454-2407