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Radiological evaluation of the urinary tract in children with urinary infection
K Jothilakshmi1, B Vijayaraghavan, S Paul
1Departments of Pediatrics, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India. psgimsr@md3.vsnl.net.in
Insights
Ultrasound effectively detects urinary tract anomalies in children with urinary tract infections (UTI). However, micturating cystourethrogram (MCU) is crucial for boys under two to avoid missing one-third of structural abnormalities.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Background:
- Urinary tract infections (UTI) are common in children.
- Structural abnormalities of the urinary tract can predispose children to UTIs.
- Early detection of these anomalies is crucial for effective management and prevention of complications.
Purpose of the Study:
- To investigate the association between structural urinary tract abnormalities and UTIs in children.
- To evaluate the efficacy of ultrasound in detecting these anomalies.
- To determine the role of micturating cystourethrogram (MCU) in conjunction with ultrasound.
Main Methods:
- A cohort of 262 children with culture-proven UTI was studied.
- Abdominal ultrasound was performed within three weeks of diagnosis.
- Micturating cystourethrogram (MCU) was conducted for lower urinary tract abnormalities or recurrent infections.
- Intravenous urography (IVU) and renal isotope scans were used selectively.
Main Results:
- Fifty-four (20.6%) children had underlying urinary tract anomalies.
- Ultrasound detected 42 anomalies, while MCU identified 12.
- The incidence of anomalies was higher in males (22.9%) than females (15.9%).
- Children under two years old exhibited the highest incidence of anomalies.
Conclusions:
- Pelviureteric junction obstruction, vesicoureteric reflux, and non-refluxing megaureter were the most common anomalies.
- Ultrasound identified three-fourths of structural abnormalities.
- An abdominal ultrasound is recommended for all children after their first UTI.
- MCU is indicated for all boys under two with UTI to prevent missed diagnoses.
Objective:
This article in to study the association of structural abnormalities of the urinary tract in children with urinary tract infection (UTI) using ultrasound examination.
Methods:
262 children with culture proven urinary tract infection were studied. Antibiotics were given as per sensitivity pattern. All children had an ultrasound of the abdomen done within 3 weeks. A micturating cystourethrogram (MCU) was done in those with abnormalities of the lower urinary tract detected on ultrasound, as well as in those who had recurrence of infection, after a normal ultrasound. IVU and renal isotope scans were done in selected cases.
Result:
All children were followed up until one year after the study period. Fifty-four patients had an underlying urinary tract anomaly; 42 were picked up by ultrasound and 12 by MCU. 22.9% of males and 15.9% of females had anomaly of the urinary tract. Children less than 2 years had the highest incidence of anomalies.
Conclusion:
Pelviureteric junction obstruction with hydronephrosis, vesicoureteric reflux and non-refluxing megaureter are the major anomalies picked up. 20% of children with urinary tract infections have an underlying structural abnormality of the urinary tract, three-fourth of which are picked up on ultrasound. An ultrasound abdomen is recommended in all children after the first UTI. In addition, an MCU is also indicated in all boys below 2 years with UTI, since one-third of anomalies will be missed if only ultrasound is done.