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Evaluation of bladder instability in children with recurrent urinary tract infections
Wiesława Winiecka1, Walentyna Zoch-Zwierz, Anna Wasilewska
11st Department of Pediatrics Diseases, Medical University of Białystok, Poland.
Insights
Detrusor muscle instability is a common lower urinary tract issue in children with recurrent urinary tract infections (UTI). This condition was more prevalent in children who also had vesicoureteral reflux (VUR).
Area of Science:
- Pediatric Urology
- Pediatric Nephrology
- Lower Urinary Tract Dysfunction
Background:
- Recurrent urinary tract infections (UTI) and vesicoureteral reflux (VUR) in children can stem from lower urinary tract functional impairments.
- Evaluating the prevalence of bladder instability in pediatric UTI cases is crucial for understanding underlying causes.
Purpose of the Study:
- To determine the frequency of bladder instability in children diagnosed with recurrent urinary tract infections (UTI).
- To compare the incidence of bladder instability between children with recurrent UTI and those with both recurrent UTI and VUR.
Main Methods:
- Urodynamic testing, including uroflowmetry and cystometry, was performed on 114 children (ages 5-16).
- Participants were divided into two groups: 61 with recurrent UTI and 53 with recurrent UTI and VUR.
- Profilometry was utilized in select cases using a Duet apparatus.
Main Results:
- Abnormal lower urinary tract function was identified in 74% of children with UTI and 84% with UTI and VUR.
- Detrusor muscle instability was the most frequent dysfunction, observed in 45% of all participants (38% in UTI group, 55% in UTI+VUR group).
- Symptoms like nocturnal wetting and urinary urgency were reported by approximately 80% of children.
Conclusions:
- Detrusor muscle instability is the primary lower urinary tract disturbance in children with recurrent UTI.
- The incidence of detrusor muscle instability is higher in pediatric patients with co-occurring VUR.
Background:
Impairment in the functions of the lower urinary tract can be the cause of recurrent urinary tract infections (UTI) and vesicoureteral reflux (VUR) in children. The purpose of our research was to evaluate the frequency of occurrence of bladder instability in children with UTI.
Material/Methods:
The research involved 114 children (21 boys, 93 girls), ranging in age from 5 to 16. Group I consisted of 61 children with a history of recurrent UTI, while Group II included 53 children with recurrent UTI and VUR. Urodynamic tests (uroflowmetry and cystometry) were done on all the children, while in selected cases profilometry was also performed, using a Duet apparatus (Dantec Medical A/S).
Results:
Abnormal functioning of the lower urinary tract was found in 45 children (74%) from Group I and 44 children (84%) from Group II. The most common dysfunction was instability of the detrusor muscle, which was found in 52 children (45%), including 23 (38%) from Group I and 29 (55%) from Group II. In 19 children detrusor instability was accompanied by reduced bladder volume, and in 8 cases there was a lack of detrusor-sphincter coordination. In both groups ca. 20% of the children did not present with symptoms indicating urination dysfunctions. Ca. 80% reported various symptoms, of which the most common were nocturnal wetting and urinary urgency. In half of the children from Group I and one-fourth of the children from Group II there were several co-occurring symptoms: nocturnal and diurnal wetting, pollakiruria, and urinary urgency, or all three symptoms simultaneously.
Conclusions:
The most common disturbance of lower urinary tract functioning in these children with recurrent UTI was instability of the detrusor muscle, which occurred more often in children with VUR.