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Prevalence of urinary tract infection and vesicoureteral reflux in children with lower urinary tract dysfunction
Jason P Van Batavia1, Jennifer J Ahn, Angela M Fast
1Divisions of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian and Columbia University Medical Center, New York, New York.
Insights
Pediatric lower urinary tract dysfunction (LUTD) is frequently linked to urinary tract infections (UTIs). This study found a significantly higher UTI history in girls with LUTD compared to boys, especially with conditions causing urinary stasis.
Area of Science:
- Pediatric Urology
- Urodynamics
- Pediatric Nephrology
Background:
- Lower urinary tract dysfunction (LUTD) is a prevalent pediatric urological issue.
- Urinary tract infections (UTIs) are commonly associated with LUTD.
Purpose of the Study:
- To determine the prevalence of a UTI history in children with LUTD.
- To investigate the association between UTI history and factors like gender, bowel dysfunction, vesicoureteral reflux, and specific LUTD conditions.
Main Methods:
- Retrospective chart review of pediatric patients diagnosed with LUTD.
- Data collected included UTI history (febrile/afebrile), gender, bowel dysfunction, and vesicoureteral reflux.
- Voiding cystourethrogram/videourodynamics were analyzed for reflux detection.
Main Results:
- 33% of 623 children with LUTD had a UTI history; 53% of girls vs. 5% of boys (p <0.001).
- Detrusor underutilization disorder was significantly associated with a higher UTI history (p <0.01).
- Vesicoureteral reflux was identified in 69% of patients with febrile UTIs and 28% with afebrile UTIs.
Conclusions:
- Females with LUTD exhibit a substantially higher incidence of UTIs than males.
- The association is strongest in LUTD conditions causing urinary stasis, such as detrusor underutilization disorder.
- Consideration of voiding cystourethrogram/videourodynamics may be beneficial for some girls with afebrile UTIs to detect vesicoureteral reflux.
Purpose:
Lower urinary tract dysfunction is a common pediatric urological problem that is often associated with urinary tract infection. We determined the prevalence of a urinary tract infection history in children with lower urinary tract dysfunction and its association, if any, with gender, bowel dysfunction, vesicoureteral reflux and specific lower urinary tract conditions.
Materials And Methods:
We retrospectively reviewed the charts of children diagnosed with and treated for lower urinary tract dysfunction, noting a history of urinary tract infection with or without fever, gender, bowel dysfunction and vesicoureteral reflux in association with specific lower urinary tract conditions.
Results:
Of the 257 boys and 366 girls with a mean age of 9.1 years 207 (33%) had a urinary tract infection history, including 88 with at least 1 febrile infection. A total of 64 patients underwent voiding cystourethrogram/videourodynamics, which revealed reflux in 44 (69%). In 119 of the 207 patients all infections were afebrile and 18 underwent voiding cystourethrogram/videourodynamics, which revealed reflux in 5 (28%). A urinary tract infection history was noted in 53% of girls but only 5% of boys (p <0.001). Patients with detrusor underutilization disorder were statistically more likely to present with an infection history than patients with idiopathic detrusor overactivity disorder or primary bladder neck dysfunction (each p <0.01).
Conclusions:
Females with lower urinary tract dysfunction have a much higher urinary tract infection incidence than males. This association was most often noted for lower urinary tract conditions in which urinary stasis occurs, including detrusor underutilization disorder and dysfunctional voiding. Reflux was found in most girls with a history of febrile infections. Since reflux was identified in more than a quarter of girls with only afebrile infections who were evaluated for reflux, it may be reasonable to perform voiding cystourethrogram or videourodynamics in some of them to identify reflux.
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