Lower urinary tract dysfunction in girls with untreated asymptomatic or covert bacteriuria

A total of 50 to 80% of all girls with asymptomatic or covert bacteriuria will have recurrences after antibacterial treatment. Deficient bladder emptying is an important factor predisposing to urinary infections. We investigated lower urinary tract function in 57 girls with untreated so-called asymptomatic bacteriuria. Detailed questioning revealed a high frequency of symptoms, such as urgency and incontinence. The symptoms were not acute and no patient had dysuria. The urinary flow curve pattern indicated bladder emptying problems in 42% of the girls and residual urine of greater than 5 ml. was seen in 71%. Cystometry revealed consistent detrusor instability in 75% of the patients. Lower urinary tract dysfunction may explain the marked tendency for recurrent infection after treatment of asymptomatic bacteriuria. With a detailed history, and noninvasive determination of urinary flow and residual urine, these abnormalities are easily detected. Bladder rehabilitation may offer a new method of treatment for these patients.