Prevalence of Urinary Tract Infection and Vesicoureteral Reflux in Children with Lower Urinary Tract Dysfunction

• Published in: The Journal of urology Vol. 190; no. 4; pp. 1495 - 1500
• Main Authors: Van Batavia, Jason P, Ahn, Jennifer J, Fast, Angela M, Combs, Andrew J, Glassberg, Kenneth I
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2013; Elsevier
• Subjects: Bacterial diseases; Bacterial diseases of the urinary system; Biological and medical sciences; Child; Female; Follow-Up Studies; Human bacterial diseases; Humans; Incidence; Infectious diseases; lower urinary tract symptoms; Male; Medical sciences; muscle; Nephrology. Urinary tract diseases; New York - epidemiology; Prevalence; Retrospective Studies; smooth; Surveys and Questionnaires; urinary bladder; Urinary Bladder - physiopathology; Urinary system involvement in other diseases. Miscellaneous; urinary tract infections; Urinary Tract Infections - epidemiology; Urinary Tract Infections - etiology; Urinary Tract Infections - physiopathology; Urinary tract. Prostate gland; Urination Disorders - complications; Urination Disorders - diagnosis; Urination Disorders - physiopathology; Urodynamics; Urography; Urology; vesico-ureteral reflux; Vesico-Ureteral Reflux - epidemiology; Vesico-Ureteral Reflux - etiology; Vesico-Ureteral Reflux - physiopathology; New York; DO; UTI; PBND; PVR; vesico-ureteral reflux; DUD; DV; IDOD; LUT symptoms; voiding cystourethrogram; vesicoureteral reflux; muscle; VCUG; lower urinary tract symptoms; primary bladder neck dysfunction; dysfunctional voiding; lower urinary tract; EMG; smooth; idiopathic detrusor overactivity disorder; urinary bladder; detrusor overactivity; VUDS; videourodynamics; LUT; LUTS; VUR; electromyography; urinary tract infections; post-void residual urine; detrusor underutilization disorder; urinary tract infection; Human; Nephrology; Urinary system disease; Prevalence; Urinary tract disease; Epidemiology; Urology; Voiding dysfunction; Urinary tract infection; Urinary system; Urinary bladder; Vesicoureteral reflux; Bladder disease; Muscle; Child; Lower urinary tract symptoms
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1016/j.juro.2013.02.016

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.