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Imaging after urinary tract infection in male neonates
M Goldman1, E Lahat, S Strauss
1Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel.
Insights
Urinary tract anomalies are common in male neonates with urinary tract infections (UTI). Ultrasound and voiding cystourethrogram are recommended for diagnosis, with renal scans reserved for specific cases.
Area of Science:
- Pediatric Nephrology
- Medical Imaging
- Neonatal Urology
Background:
- Urinary tract infections (UTI) in male neonates can indicate underlying urinary tract anomalies.
- Early diagnosis and appropriate imaging are crucial for managing neonatal UTI and preventing complications.
Purpose of the Study:
- To determine the incidence of urinary tract anomalies in male neonates under 8 weeks old presenting with UTI.
- To evaluate the effectiveness of different imaging modalities for diagnosing these anomalies.
Main Methods:
- A retrospective study of 45 male neonates hospitalized with UTI over 4.5 years.
- All neonates underwent ultrasound (US) and voiding cystourethrogram (VCUG).
- Dimercaptosuccinic acid (DMSA) renal scans were performed in select cases, typically after 4 months post-infection.
Main Results:
- Urinary tract anomalies were found in 22 of 45 (48.9%) male neonates.
- Vesicoureteral reflux (VUR) was the most common anomaly (19 cases).
- Renal scars or atrophy on DMSA scans were primarily associated with high-grade VUR (grade 3 and above).
Conclusions:
- Routine ultrasound and voiding cystourethrogram are recommended for male neonates following an initial UTI.
- DMSA renal scans should be reserved for cases with suspected renal parenchymal damage on US or high-grade VUR detected by VCUG.
Objective:
To assess the frequency of urinary tract anomalies in male neonates <8 weeks old who presented with urinary tract infection (UTI), and to evaluate a suitable imaging approach after the initial infection.
Design:
During a period of 4.5 years, from July 1994 through December 1998, 45 male neonates <8 weeks old (range: 5-56 days; mean: 23.77 days) with UTI were hospitalized. All patients had an ultrasound (US) and a voiding cystourethrogram (VCUG), except 1 neonate in whom VCUG was unsuccessful because of technical problems. A dimercaptosuccinic acid (DMSA) scan was recommended to all patients but was performed only in 30 of 45, most of them with an abnormal VCUG. The renal scan was performed at least 4 months after the UTI.
Results:
Urinary tract abnormalities were observed in 22 of 45 male neonates. Nineteen had vesicoureteral reflux (VUR), 1 had VUR and a double collecting system, 1 had VUR and a posterior urethral valve, and 1 had an ureteropelvic junction stricture. Renal atrophy or scars, as demonstrated by DMSA scan, were detected almost exclusively in neonates with VUR grade 3 and above. Only 1 neonate with VUR grade 1 had a pathologic DMSA, and the US of this male also demonstrated renal atrophy. Escherichia coli was the pathogen in 62% (28 of 45), and 9 boys had bacteremia.
Conclusion:
We suggest that US and VCUG should be performed routinely after the initial UTI in male neonates. Renal scan should be reserved for those cases in which the US suggests renal parenchymal damage or when VCUG detects VUR grade 3 and above.
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