Urology - UTIs

Question 1

What are the symptoms of UTIs in kids?

Answer 1

Fever can sometimes be the only symptom especially in young children

• Suprapubic pain
• Vomiting
• Dysuria
• Urinary frequency
• Incontinence

Question 2

What are the symptoms of UTIs in babies?

Answer 2

Non-specific symptoms
- Fever
- Lethargy
- Irritability
- Vomiting
- Poor feeding
- Urinary frequency

Question 3

When is acute pyelonephritis diagnosed?

Answer 3

Temperature greater than 38
Loin pain or tenderness

Question 4

What is the ideal urine sample for a urine dip?

Answer 4

Clean catch sample

Tricky in young children, babies and girls

Clean catch is important to avoid contamination

Question 5

What do nitrites and leukocytes indicate?

Answer 5

Nitrites - gram negative bacteria break down nitrates to nitrites, if positive suggests bacteria

Leukocytes - urine dip tests leukocyte esterase, product of leukocytes

Nitrites are a better indicator of infection, if both present UTI, if nitrites only, most likely UTI, if only leukocytes not treated unless clear evidence

MSU to be cultured and have sensitives done

Question 6

How are UTIs managed?

Answer 6

All children under 3 months with fever should start immediate IV antibiotics (ceftriaxone) and start a full septic screen

Over 3 months, start oral antibiotics if they are well

Question 7

What antibiotics are used for UTIs in kids?

Answer 7

Trimethoprim
Nitrofurantoin
Cefalexin
Amoxicillin

Question 8

What are recurrent UTIs investigated for and how?

Answer 8

Underlying cause and any renal damage

USS
DMSA scan
Micturating cystourethrogram - look for vesico-ureteric reflux

Question 9

What are the guidelines for USS in UTI investigation?

Answer 9

• All children under 6 months with first UTI should have an abdo USS within 6 weeks, or during illness if there are recurrent UTIs or atypical bacteria
• Children with recurrent UTIs should have an abdominal ultrasound within 6 weeks
• Children with atypical UTIs should have an abdominal ultrasound during illness

Question 10

What are the guidelines for DMSA Scans in UTI investigation

Answer 10

Used 4 – 6 months after the illness to look for damage from recurrent or atypical UTIs

Radioactive material (DMSA)injected and gamma camera used to see how much DMSA is taken up by kidneys

Patches of kidney that have not taken up DMSA indicates scarring due to previous infection.

Question 11

Why is it important to look at vesico-ureteric reflux?

Answer 11

This is where urine can flow from bladder back into ureters

Predisposes patient to UTIs and renal scarring

Diagnosed with micturating cystourethrogram

Question 12

How is vesico-ureteric reflux managed?

Answer 12

• Avoid constipation
• Avoid excessively full bladder
• Prophylactic antibiotics
• Surgical input

Question 13

What are the guidelines for using micturating cystourethrogram?

Answer 13

Used to investigate atypical or recurrent UTIs in children under 6 months

Also used if:
- Family history of vesico-ureteric reflux
- Dilatation of the ureter on ultrasound
- Poor urinary flow

Child catheterised, contrast is injected into bladder x-rays taken to see if contrast refluxes into ureters

Children are usually given prophylactic antibiotics for 3 days around the time of the investigation