Constipation on abdominal radiograph as potential risk factor for recurrent urinary tract infection development

Area of Science:

• Pediatric Nephrology
• Diagnostic Imaging
• Gastroenterology

Background:

• Urinary tract infections (UTIs) are common in children.
• Predicting recurrent UTIs is crucial for effective management.
• Fecal impaction is a potential contributing factor to UTIs.

Purpose of the Study:

• To evaluate the utility of clinical history and fecal load measurements on abdominal radiography (AR) in predicting recurrent UTIs in children.
• To compare the predictive accuracy of these methods.

Main Methods:

• Combined data from two multicenter longitudinal studies of children under 6 years with a first or second UTI.
• Two radiologists measured fecal load (cecal diameter, rectal diameter, total stool length) on scout abdominal radiographs.
• Clinical variables and fecal load measurements were analyzed for prediction of UTI recurrence within 12 months.

Main Results:

• 192 children were included in the analysis.
• Univariate analysis showed age, vesicoureteral reflux (VUR), cecal diameter, rectal diameter, and total stool length were associated with UTI recurrence.
• Elevated cecal diameter (> 3.10 cm) was linked to a 2.57 times higher likelihood of recurrent UTI and shorter time to recurrence.

Conclusions:

• Cecal diameter on abdominal radiographs can predict UTI recurrence in children with a prior UTI.
• The accuracy of cecal diameter measurement is suboptimal for routine screening.
• Consider managing constipation if cecal diameter is elevated on an AR obtained for other indications.