影像尿动力学评估先天性膀胱输尿管返流患儿的膀胱功能障碍

目的 采用影像尿动力学评估小儿先天性膀胱输尿管返流(VUR)与膀胱功能障碍的关系.方法 选取2011年4月至2013年7月在郑州大学第一附属医院就诊的67例VUR患儿为研究对象.患儿经影像尿动力学、尿常规、排泄性尿路造影等检查,记录患儿尿路感染、逼尿肌过度活动、逼尿肌括约肌协同失调及VUR程度等情况,根据尿动力学表现的不同分为正常组、单纯逼尿肌过度活动组和逼尿肌括约肌协同失调组(伴或不伴逼尿肌过度活动的逼尿肌括约肌协同失调),另外按照返流级别将患儿分为低级别返流(Ⅰ～Ⅱ度)和高级别返流(Ⅲ～Ⅴ度),分析膀胱功能与VUR侧别、返流程度以及尿路感染的关系.结果 VUR患儿合并膀胱功能异常占73.1％(49/67例),其中膀胱过度活动症占49.3％(33/49例),逼尿肌括约肌协同失调占23.8％(16/49例).单纯膀胱过度活动患儿多为单侧,Ⅰ～Ⅱ度返流,且较少合并尿路感染.而逼尿肌括约肌协同失调的患儿多为双侧,Ⅲ～Ⅳ度返流,且较多见尿路感染.结论 影像尿动力学可以准确诊断VUR,同时对患儿膀胱功能的评估,及临床制定治疗方案提供重要参考.     

后尿道瓣膜切除术后尿动力学研究

目的探讨后尿道瓣膜患儿行经尿道镜瓣膜切除术后的尿动力学改变.方法回顾性分析2007年1月至2008年12月本院收治的17例因后尿道瓣膜经尿道镜瓣膜切除术患儿的临床资料.均采取问卷调查、排尿性膀胱尿道造影、静脉肾盂造影、泌尿系超声、尿动力学检查等进行随访,重点分析尿动力学检查结果.结果诊断时常见症状排序依次为排尿困难、泌尿系感染症状、尿失禁等.术前发现肾积水17例,膀胱输尿管反流9例.均行经尿道镜瓣膜切除术.平均随访时间27(15～40)个月.临床症状均消失或减轻,无尿道狭窄、尿道瘘,造影检查提示解剖性梗阻均已解除,9例肾积水较前好转;8例存在膀胱输尿管反流.16例(94.1%)存在尿动力学异常,7例(41.2%)表现为膀胱顺应性降低,平均最大逼尿肌压力降低,逼尿肌不稳定;7例(41.2%)表现为残余尿增多.8例(47.1%)膀胱容量低于同年龄正常预测值的80%.结论后尿道瓣膜切除术后膀胱功能异常仍然存在,尿动力学检查能及时发现膀胱功能损害及其程度,建议PUV患儿术后定期行尿动力学检查,以了解膀胱功能,保护上尿路.     

伴排尿障碍的隐性脊柱裂患儿的尿动力学特点

目的 研究伴有排尿功能障碍的隐性脊柱裂患儿的尿动力学特征.方法 对113例有排尿障碍的患儿进行尿动力学检查,其中48例经X线确诊为隐性脊柱裂者为观察组,无脊柱裂65例为对照组.检测项目包括:尿流率测定、充盈期膀胱压力容积测定、压力流率测定、同步括约肌肌电测定、静态尿道压力测定.比较两组间主要尿动力参数异常的发生率.观察组按主要临床症状分为尿失禁、尿频、单纯夜间遗尿和排尿困难4组,应用统计学研究临床症状与尿动力学主要参数的相关性.结果 在检测中发现观察组48例中有46例有不同程度的异常.其中逼尿肌过度活动22例,排尿期逼尿肌活动低下和无收缩21例,最大尿流率降低18例,膀胱容积缩小15例,残余尿量增多12例,低顺应性膀胱7例,逼尿肌外括约肌协同失调4例,最大尿道压降低4例.观察组中逼尿肌过度活动、逼尿肌活动低下、残余尿量增多及低顺应性膀胱发生率更高.按临床症状来看,隐性脊柱裂伴有尿失禁的患儿更多的表现为逼尿肌活动低下及最大尿流率降低,尿频的患儿在尿动力检查中多表现为逼尿肌过度活动及残余尿增多,排尿困难的患儿逼尿肌活动低下的发生率更高,而遗尿的患儿更易检出逼尿肌过度活动.结论 小儿隐性脊柱裂伴有排尿功能障碍的患儿具有多种尿动力学改变,且相同的症状可表现为不同类型的尿动力学异常,临床症状与尿动力学参数有一定的相关性,尿动力检查为其临床诊断和治疗方案制定提供重要客观依据.     

小儿膀胱输尿管反流87例相关尿动力学因素研究

目的 探讨小儿膀胱输尿管反流(vesicoureteric reflux,VUR)的尿动力学表现特点,为小儿VUR的诊断和治疗提供临床参考.方法 选取在郑州大学第一附属医院小儿尿动力学中心就诊的VUR患儿87例(男58例,女29例);年龄4～12岁,平均6岁.另选取因下尿路症状就诊而尿动力学检查无异常且无VUR小儿60例(男38例,女22例)作为对照组;年龄4～12岁,平均6岁.将VUR患儿依据反流的程度分为轻度(Ⅰ度,15例)、中度(Ⅱ度和Ⅲ度,33例)、重度(Ⅳ度和Ⅴ度,39例).尿动力观察参数包括:最大尿流率、残余尿量、最大逼尿肌收缩压力、最大膀胱容量和膀胱顺应性.结果 VUR组的最大尿流率和最大膀胱容量分别为(6.8±6.3)ml/s和(138.5±73.9)ml,均明显低于对照组(16.1±6.7)ml/s和(285.5±107.5)ml,组间比较,差异有统计学意义(P＜0.05).VUR组残余尿量为(95.9±103.4)ml明显高于对照组(9.6±13.9)ml,差异有统计学意义(P＜0.05).VUR组最大逼尿肌压力为(41.6±22.2)cmH2O与对照组(35.1±13.0) cmH2O比较,差异无统计学意义(P-0.229).VUR组男、女童尿动力学参数差异无统计学意义(P＞0.05).VUR组轻度反流(15例)、中度反流(33例)和重度反流(39例)的最大膀胱容量分别为(121.83±69.94) ml、(163.73±80.81)ml和(123.58±68.70) ml,组间比较,差异无统计学意义(P＞0.05).轻度反流组顺应性正常12例(80％),中度反流组12例(36.4％),重度反流组9例(23.1％),三组间差异有统计学意义(P＜0.05).结论 最大尿流率降低、最大膀胱容量减少、残余尿量增多和膀胱顺应性差可能是VUR发生的相关因素.     

小儿后尿道瓣膜切除后合并排尿异常的尿动力学研究

目的 探讨经尿道镜后尿道瓣膜切除术后伴有排尿异常患儿上尿路、膀胱功能及预后.方法 回顾性分析2002年7月至2012年2月收治的行尿道镜电灼后尿道瓣膜术后获得随访的58例患儿的病例资料,归纳总结其存在的临床症状、影像学异常以及尿动力学检查结果,并将其分为排尿正常组(10例)和排尿异常组(48例),对其年龄分布、上尿路情况、尿动力学参数进行比较分析.结果 术后仍存在的临床症状有:尿失禁18例(31.0％),反复泌尿系感染8例(13.8％),排尿费力、滴尿15例(25.9％),尿频4例(6.9％),尿不尽5例(8.6％),无明显症状10例(17.2％),肾功能衰竭3例(5.2％).影像学检查示:术后仍存在双肾积水者50例91侧(86.2％),存在膀胱输尿管反流23例27侧(39.7％).58例患儿中56例(96.6％)存在不同程度的尿动力学异常.逼尿肌不稳定者占16例(27.6％％);逼尿肌收缩无力者6例(10.3％);残余尿量＞10 ml者25例(43.1％);腹压参与排尿者23例(39.7％).比较排尿正常组与排尿异常组单侧肾输尿管积水比例(11.1％ vs 88.9％)、双侧肾输尿管积水比例(9.8％ vs 90.2％)、单侧膀胱输尿管反流比例(6.7％ vs 93.3％)、双侧膀胱输尿管反流比例(12.5％ vs 87.5％),差异均具有统计学意义(P＜0.05).排尿正常组与排尿异常组逼尿肌漏尿点压力[(29.1±5.5)CmH2O vs (50.4±4.8)CmH2O]、膀胱顺应性[(12.1±3.8)ml/cmH2O vs (4.0±0.1)ml/cmH2O]、残余尿量比较[(21.3±8.1)ml vs (45.7±9.6)ml],差异均有统计学意义(P＜0.05).结论 后尿道瓣膜患儿解除梗阻后多数患儿仍存在不同程度膀胱功能问题,排尿异常组膀胱功能及上尿路情况明显差于排尿正常组.后尿道瓣膜患儿术后应注意排尿情况,定期做尿动力学检查,对症处理,以更好的保护肾功能.     

遗尿伴急迫性和排尿延缓性尿失禁患儿膀胱功能的尿动力学评估

目的 探讨夜间遗尿伴白天急迫性尿失禁(UI)和夜间遗尿伴白天排尿延缓性尿失禁(VPI)患儿的尿流动力学表现,为临床治疗提供依据.方法 本研究选取2008年6月至2009年10月间因夜间遗尿伴白天尿失禁诊断的患儿64例,进行详细的体格检查、腰椎X线、泌尿系超声并测定膀胱壁厚度、尿常规,尿动力学检查.将患儿分为UI和VPI两组.结果 UI组与VPI组比较:膀胱壁厚度较正常增厚比例(5%比20%,P＜0.05),两组中伴随尿痛、便秘等显著临床症状(13%比36%,P＜0.05).最大尿流率VPI组与UI组分别为(20.2±9.0)ml/s、(14.1±11.6)ml/s(P＜0.05),最大尿道压VPI组与UI组分别为(152.3±47.5)cmH2O、(107.7±40.3)cmH2O(P＜0.05).结论 VPI患儿更易出现躯体不适及明显临床症状,VPI的尿动力改变和临床症状明显较UI严重,这些儿童有必要常规行尿动力学检查了解膀胱功能,为规范治疗提供依据.

Abstract：

Objective To evaluate the urodynamic parameters of the children with enuresis nocturna accompanied by daytime urgency incontinence(UI) or daytime voiding postponement incontinence(VPI).Methods From June 2007 to October 2009,a total of 64 children who had enuresis nocturna accompanied by daytime UI or daytime VPI were recruited in this studv.The urodynamics parameters including uroflowmetry,bladder pressure-volume,and static urethral pressure were examined and recorded.The physical examination,X-ray radiography,ultrasonography and urinalysis were of UI patients had thicker bladder wall(P＜0.05).Pain with urinating and constipation occurred in 13% UI patients,and 36%VPI patients(P＜0.05).The maximum flow rate in VPI patients was higher than that in UI patients(20.20±9.02 vs.14.09±11.56 ml/s,P＜0.05).Maximum urethral pressure in VPI patients was higher than that in UI patients(1 52.3±47.5 vs 107.7±40.3 cmH2O,P=0.003).Conclusions The symptoms and urodynamic dysfunction of the children with enuresis nocturna accompanied by VPI are more severe than those of the UI patients.The therapeutic plan should be made according to the urodynamic evaluations of these patients.     

婴幼儿尿路感染61例影像学分析

目的 观察影像学检查在婴幼儿尿路感染诊断、治疗中的作用.方法 回顾性分析2008 - 2009年61例婴幼儿尿路感染的影像学检查,2008年尿路感染患儿21例,所有患儿完成尿路超声检查,其中23.8%行肾静态显像(DMSA)筛查,9.5%行排尿性膀胱尿道造影(MCU)检查;2009年尿路感染患儿40例,所有患儿均完成尿路超声、DMSA筛查,72.5%行MCU检查.结果 2008年未发现膀胱输尿管反流(VUR)患儿,不排除有漏诊可能;2009年发现VUR14例,其中Ⅱ级反流2支,Ⅲ级反流4支,Ⅳ级反流9支,Ⅴ级反流6支,以高级别反流为主,无Ⅰ级反流.结论 婴幼儿尿路感染的影像学检查,尿路超声仍应作为首选,DMSA应予常规检查,DMSA异常患儿行MCU检查,以早期诊断VUR给予合适的治疗而减少肾损伤发生.     

小儿神经源性膀胱伴膀胱输尿管反流临床特点分析

目的 探讨神经源性膀胱（NB）患儿伴膀胱输尿管反流（VUR）的临床特征,为其临床早期诊断及治疗提供参考依据。方法 收集2014年1月至2019年12月于儿童肾内科收治并诊断为NB伴尿路感染的26例患儿的临床资料,根据有无VUR分为反流组（11例）与无反流组（15例）,分析比较两组的临床特点。结果 相比无反流组,反流组患儿更易出现非大肠杆菌性尿路感染、肾积水（反流等级越高肾积水越严重）、锝[^99mTc]二巯丁二酸肾脏核素扫描异常（P < 0.05）。反流组患儿尿白蛋白/肌酐、尿IgG/肌酐、尿转铁蛋白/肌酐高于无反流组（P < 0.05）。与无反流组比较,反流组患儿残余尿量增多,逼尿肌漏尿点压力升高（P < 0.05）。结论 当NB患儿出现非大肠杆菌性尿路感染、肾积水、锝[^99mTc]二巯丁二酸肾脏核素扫描异常、肾小球性蛋白尿、膀胱残余尿增多及逼尿肌漏尿点压力升高等临床表现时,患儿可能已出现VUR,应及早明确诊断与干预治疗。     

305例原发性遗尿症儿童尿流率检测结果分析

目的通过分析尿流率检测结果评价原发性遗尿症患儿的膀胱尿道功能。方法选择2001年10月￣2005年8月在我院尿动力学室进行尿流率检测的原发性遗尿症患儿。患儿先饮水,待有强烈尿意时,在不受干扰的环境中采取自然体位排尿于尿流率测量仪器上。记录最大尿流率、平均尿流率、排尿时间、尿流时间、尿量、达峰时间及尿流曲线等,同时于肛门口贴电极片同步测量盆底肌募集肌电图。结果原发性遗尿症患儿共305例,男183例,女122例。平均年龄8.4±0.3岁(5～18岁)。白天有尿频、尿急、湿裤症状的复杂性遗尿病例225例,占73.8%;单症状性夜间遗尿病例80例,占26.2%。88.2%的患儿有效膀胱容量减小,其中单症状性夜间遗尿患儿中,82.1%存在有效膀胱容量减小,而复杂性遗尿患儿中90.0%有此现象,二者相比,差异有统计学意义(P<0.05)。7～14岁女孩最大尿流率平均为19.7±1.2ml/s,明显小于正常(P<0.05),男孩为18.6±1.1ml/s。尿流率曲线中钟形曲线占54.8%;Staccato排尿曲线占12.5%;间断排尿曲线占7.2%;功能性膀胱出口梗阻形曲线占14.4%。128例(占42.0%)患儿排尿时出现收缩的肌电图信号。结论通过尿流率分析发现部分原发性遗尿症患儿存在膀胱尿道功能异常,表现为有效膀胱容量减小、最大尿流率降低和逼尿肌-括约肌收缩不协调等。与尿动力学检查相比,尿流率检测无创易行,值得在原发性遗尿症儿童中进行。     

原发性夜遗尿症尿动力学检查评估

目的探讨原发性夜遗尿(PNE)儿童的尿动力学表现形式并评估其价值。方法156例PNE患儿分单症状性遗尿(MPE)(120例)和复杂性遗尿(CPE)(36例)二组。因上尿路疾病需要手术治疗而下尿路功能正常的20例患儿作对照组,进行膀胱压力容积、压力流率和静态尿道压力分布测定。结果MPE组中,逼尿肌不稳定收缩占56.7%(68/120)例,膀胱顺应性下降占3.3%(4/120)例,最大膀胱容量/正常膀胱容量≤80%9例;CPE组中,逼尿肌不稳定收缩占80.6%(29/36)例,膀胱顺应性降低占22.2%(8/36)例,最大膀胱容量/正常膀胱容量≤80%12例,二组比较差异有显著性意义(P<0.01)。MPE组中,尿道高压66例,逼尿肌括约肌协同失调78例;CPE组中,尿道高压25例,逼尿肌括约肌协同失调21例,二组比较差异无显著性意义(P>0.05)。MPE,CPE中逼尿肌不稳定收缩、逼尿肌括约肌协同失调和尿道压增高的发生率高于对照组,而CPE中顺应性下降的发生率显著高于对照组。结论尿动力学检查结果提示MPE、CPE二组遗尿患儿尿动力学检查的必要性。     

Evaluation of voiding dysfunctions in children with chronic functional constipation

There are controversial results about the role of dysfunctional bowel emptying in disorders of the urinary tract like urinary tract infection (UTI), vesicoureteral reflux (VUR) and enuresis. Constipation may cause UTI, enuresis and VUR due to the uninhibited bladder contraction. The aim of this study was to investigate the frequency of nocturnal enuresis, UTI and instability symptoms in chronic functional constipation (CFC). This study included 38 children with CFC and 31 children as the control group. Detailed past and present history of UTIs or symptoms pointing to this diagnosis, enuresis, encopresis, urgency and urge incontinence was obtained from both groups as well as the family history of UTI. Urinalysis, urine culture and stool parasite analysis as well as abdominal ultrasonography were performed on both groups. Age range of the children with CFC was 6-192 months (mean +/- standard deviation (SD) 63.5 +/- 51 months); that of the control group was 4-180 months (mean +/- SD 82 +/- 46.2 months). Frequency of UTI and urgency was significantly higher in the CFC group. However, frequencies of urge incontinence, nocturnal enuresis, and genitourinary abnormalities were not different between the two groups. In conclusion, risk of UTI and urgency is increased in CFC, but that of other voiding dysfunctions like urge incontinence do not change significantly. Therefore, we suggest that UTI and urgency should be questioned in children with CFC and vice versa.     

Voiding dysfunction in pediatric patients

The goals of this study were to describe the pattern of voiding disorders in children in our community, to describe clinical criteria for making the specific diagnoses, and to comment on management. The medical records of 226 children referred because of voiding dysfunction or urinary tract infections (UTI) were evaluated. Children with normal voiding patterns when uninfected, with monosymptomatic nocturnal enuresis, and with known neurologic or anatomic abnormalities were excluded. Detrusor instability, an abnormal voiding pattern characterized by urgency with or without frequency, was the diagnosis in 175 of the 226 children. Children with detrusor instability who used various posturing maneuvers to avoid urinary incontinence had a significantly higher incidence of UTIs than those who did not attempt to obstruct urine outflow. Detrusor instability appeared to be secondary to constipation in 19 of the children. The other diagnoses were extraordinary daytime urinary frequency, infrequent voiding, monosymptomatic daytime wetting, transient voiding dysfunction, giggle incontinence, dysfunctional voiding, and unexplained dysuria. It is concluded that children with detrusor instability who use posturing maneuvers to avoid incontinence are at high risk for recurrent UTIs. Constipation is 1 cause of detrusor instability. Dysfunctional voiding, the form of voiding dysfunction most likely to result in renal damage, was present in only 2 of 226 children seen for voiding disorders.     

Oxybutynin efficacy in the treatment of primary enuresis

The effectiveness of oxybutynin in the treatment of primary enuresis was evaluated in a double-blind study. A total of 30 children (25 boys, five girls), at least 6 years of age, with primary enuresis and no daytime incontinence or history of other urinary tract problems were selected at random from an enuresis clinic population. The study was explained to the families and they were told how to keep records of nocturnal bed-wetting episodes and side effects. The patients were treated with a 10 mg of oxybutynin at suppertime for 28 days. Before or after the treatment period, all children received an identical placebo for 4 weeks. Two-sided paired t tests were used to compare frequency of nocturnal enuresis. Frequency during the drug regimen did not differ significantly from that during the placebo study. There were no differences in findings between boys and girls or between children who had previously taken imipramine and those who had not. The study showed no evidence that oxybutynin is effective in treating primary enuresis.     

Risk factors for recurrent urinary tract infection in 4,332 Belgian schoolchildren aged between 10 and 14 years

To analyse the risk factors for recurrent urinary tract infection (UTI) and the possible influence of potty-training, a questionnaire with 41 questions was completed by 4,332 parents of children completing the last 2 years of normal primary school. Statistical analysis was done with the Chi-squared test and Yates correction. Three groups of children emerged: one without any history of UTI (n =3818), a group with one actual or former UTI (n =382) and a group with recurrent UTI (n =132). Mean age was 11.5±0.56 years. A strong correlation between daytime and/or night-time wetting, voiding frequency of more than 10 times a day and nocturia and recurrent UTI was found. No correlation between these factors and a single UTI could be demonstrated. In the 343 bed-wetting children, equal infections for boys and girls were found. Potty-training started significantly earlier in children without UTI. Parents of children with recurrent UTIs insisted more when the first attempt to void was unsuccessful: in the group without UTI, most parents just postponed and had the child try later again. In the group with recurrent UTI, more parents asked the child to strain, made special noises or turned on a tap. Conclusion:daytime with/without night-time wetting, more than 10 voidings a day and nocturia are indicators of recurrent urinary tract infections. If they are simultaneously present, the relative risk for recurrent urinary tract infections is 60%. Consequently, paediatricians should take urinary symptoms very seriously into account, and as incontinence is still a hidden condition, question the child on this topic.Abbreviations MNE monosymptomatic enuresis nocturna - UTI urinary tract infection - VUR vesicoureteral reflux     

Enuresis and common bladder disorders in children

Enuresis affects 5 to 10% of primary-school age children. Nocturnal enuresis, or bedwetting, is often familial and boys are mainly concerned; daytime micturitions are normal, without urine loss or urinary tract infection. Hygienic rules associated with desmopressin or, in some cases, tricyclic antidepressant agents, alarm procedures or psychotherapy, result in a 70% success rate after 1 year. Bladder instability consists of diurnal and nocturnal disturbances, mainly in girls with recurrent urinary tract infections; affected children experience pollakiuria, urine loss and voiding emergencies. Urodynamic assessment of daytime enuresis is of major interest, mainly when dysuria is present. The treatment of non complicated bladder instability needs reeducation, i.e. biofeedback and/or administration of oxybutynin chlorhydrate.     

Urinary tract infections in infants and children: Diagnosis and management

Recent studies have resulted in major changes in the management of urinary tract infections (UTIs) in children. The present statement focuses on the diagnosis and management of infants and children >2 months of age with an acute UTI and no known underlying urinary tract pathology or risk factors for a neurogenic bladder. UTI should be ruled out in preverbal children with unexplained fever and in older children with symptoms suggestive of UTI (dysuria, urinary frequency, hematuria, abdominal pain, back pain or new daytime incontinence). A midstream urine sample should be collected for urinalysis and culture in toilet-trained children; others should have urine collected by catheter or by suprapubic aspirate. UTI is unlikely if the urinalysis is completely normal. A bagged urine sample may be used for urinalysis but should not be used for urine culture. Antibiotic treatment for seven to 10 days is recommended for febrile UTI. Oral antibiotics may be offered as initial treatment when the child is not seriously ill and is likely to receive and tolerate every dose. Children <2 years of age should be investigated after their first febrile UTI with a renal/bladder ultrasound to identify any significant renal abnormalities. A voiding cystourethrogram is not required for children with a first UTI unless the renal/bladder ultrasound reveals findings suggestive of vesicoureteral reflux, selected renal anomalies or obstructive uropathy.     

Management of urinary tract infections

Urinary tract infection (UTI) is common in childhood. It may result in long-term complications due to renal scaring. Younger children are at higher risk of renal scarring. The diagnosis of UTI is based on urine culture. The bacterial count for diagnosis of UTI depends on the method of urine collection. Urinalysis is useful for making a presumptive diagnosis of UTI and allows initiation of empirical treatment in high-risk patients, after urine culture has been obtained. The treatment of UTI is guided by the severity of illness and age of the patient. Following a UTI, investigation should be performed to identify an underlying urinary tract anomaly. Recurrence of UTI occurs in 30–50% children. Important predisposing factors include VUR, urinary tract obstruction, voiding dysfunction and constipation. Vesicoureteric reflux (VUR) is seen in 30–50% children with UTI. The cornerstone of management of VUR is long-term antibiotic prophylaxis, which has been found to be as effective as surgical reimplantation.     

Risk factors for urinary tract infection in children: A population-based study of 2856 children

Aim:   To identify risk factors for urinary tract infection (UTI) in children to inform the development of preventative strategies.
Method:   A validated questionnaire covering demographic factors, perinatal, developmental, bowel and urinary history was sent to a cross-sectional sample of parents of elementary school children randomly selected from the first 4 years of school. UTI was ascertained by parental report, verified by cross-referencing with microbiological reports for all positive cases and 50 randomly selected negative cases.
Results:   Parents of 2856 children (mean age 7.3 years, range 4.8–12.8 years) responded. A total of 3.6% of children had a bacteriologically verified UTI, compared with 12.6% by parental report alone. Multivariate polychotomous logistic regression showed that a history of structural kidney abnormalities (odds ratio (OR) 15.7, 95% confidence interval 8.1–30.4), daytime incontinence (OR 2.6, 1.6–4.5), female gender (OR 2.4, 1.5–3.8), and encopresis (OR 1.9, 1.1–3.4) were independently associated with UTI. Daytime incontinence increased risk more in boys (8.3% vs. 1.2%) than girls (8.1% vs. 4.6%), and kidney problems increased risk in older compared with younger children (29% vs. 2% in ≥8 year olds, 0% vs. 4% in 4–6 year olds).
Conclusions:   Parents over-report UTI by about threefold. Effective treatment of daytime urinary incontinence and encopresis may prevent UTI in children, especially boys.     

Prediction of vesico-ureteric reflux in childhood urinary tract infection: a multivariate approach

In this study, independent predictors obtained from patient history, physical examination and laboratory results for vesico-ureteric reflux (VUR) in children of 0-5 y with a first urinary tract infection (UTI) were assessed and the added value of renal ultrasound (US) investigated. Information was collected from children visiting the paediatric outpatient department with a first proven UTI, defined as a urine monoculture with ≥105 organism/ml, with clinical symptoms and possible white cell count ≥20 per high-power field of spun fresh urine. Children with neurologic bladder dysfunction were excluded. VUR was determined by voiding cystourethrography (VCUG) and graded from I to V. The diagnostic value of predictors was judged using multivariate logistic modelling with the area under the receiver operating characteristic (ROC area). A risk score was derived based on the regression coefficients of the independent predictors in the logistic model. In 140 children (51 boys and 89 girls) VUR was diagnosed in 37. Independent predictors for VUR were male gender, age, family history for uropathology, serum C-reactive protein level (CRP) and dilatation of the urinary tract on US. The ROC area of this model was 0.78 (95% CI: 0.69-0.87). This prediction model identified 12% (95% CI: 7-18) of the patients without VUR without missing one case of VUR. If we used VUR ≥ grade 3 as a threshold, the model assessed VUR to be absent in 34% (95% CI: 26-42). Conclusion: A prediction rule based on age, gender, family history, CRP and US results is useful in assessing the probability of VUR in the individual child with a first UTI and may help the physician to make decisions about performing additional imaging techniques. Prospective validation of the model in future patients, however, will be necessary before applying the rule in practice.     

The feasibility of screening preschool children for urinary tract infection using dipslides

Preschool children were screened for urinary tract infection (UTI) using Oxoid dipslides. A colony count of greater than 10(5) per ml was obtained from 64 out of 566 boys, and 58 out of 446 girls. A diagnosis of UTI was established in 3 boys, all aged 6 months or less, and 5 girls. No child was found to have either vesico-ureteric reflux (VUR) or renal scarring. False positive results were obtained in 15-17% of male and female infants and were attributable to the obligatory use of bag urine collection. These high rates preclude the use of this method in identifying UTI in preschool children on a wide scale.