The Swedish Reflux Trial in Children: V. Bladder Dysfunction

Acute pyelonephritis is one of the most serious bacterial illnesses during childhood. Escherichia coli is responsible in most cases, however other organisms including Klebsiella, Enterococcus, Enterobacter, Proteus, and Pseudomonas species are being more frequently isolated. In infants, who are at major risk of complications such as sepsis and meningitis, symptoms are ambiguous and fever is not always useful in identifying those at high risk. A diagnosis of acute pyelonephritis is initially made on the basis of urinalysis; dipstick tests for nitrites and/or leukocyte esterase are the most accurate indicators of infection. Collecting a viable urine sample for urine culture using clean voided methods is feasible, even in young children. No gold standard antibiotic treatment exists. In children appearing well, oral therapy and outpatient care is possible. New guidelines suggest less aggressive imaging strategies after a first infection, reducing radiation exposure and costs. The efficacy of antibiotic prophylaxis in preventing recurrence is still a matter of debate and the risk of antibiotic resistance is a warning against its widespread use. Well-performed randomized controlled trials are required in order to better define both the imaging strategies and medical options aimed at preserving long-term renal function.

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“…Other host factors could include dysfunctional bladder emptying [4], detrusor instability [5], constipation, and fecal soiling.…”

Section: Etiology/physiopathologymentioning

confidence: 99%

“…(4) The usefulness of a full imaging work-up after a first fUTI is questioned. The new guidelines suggest less aggressive imaging strategies, to reduce radiation exposure and costs.…”

mentioning

confidence: 99%

Acute pyelonephritis in children

et al. 2015

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“…Relevant epidemiological studies allow for the supposition that the prevalence of LUTD in children is variable, possibly affecting between 2% and 25% of the population [3][4][5][6][7][8][9][10][11][12]. Despite this disparity in the prevalence reported in studies, in which the informants are generally the parents, LUTD is common in the pediatric population and represents a challenge for specialized interdisciplinary teams.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of lower urinary tract symptoms in school-age children

et al. 2011

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Epidemiological studies have demonstrated rates of incontinence and enuresis as high as 20% in school-age children. This cross-sectional study aimed to investigate the prevalence of lower urinary tract (LUT) symptoms in 739 children aged 6-12 years enrolled in three government schools with different socioeconomic levels in Minas Gerais, Brazil. Symptoms of LUT were evaluated using a modified version of the Dysfunction Voiding Scoring System in which the cutoff point considered as an indicator of LUT dysfunction is >6 for girls and >9 for boys. Children with a score indicative of symptoms received an educational booklet on the functioning of the LUT and were sent for clinical evaluation. LUT dysfunction symptoms were detected in 161 (21.8%) children. Symptoms were most frequent in girls (p < 0.001), children aged 6-8 (p < 0.028), and attended the school with the lowest social level (p < 0.001). Intestinal constipation was the most prevalent finding (30.7%), independent of LUT score. The most common urinary symptoms in children with an elevated score were diurnal urinary incontinence (30.7%), holding maneuvers (19.1%), and urinary urgency (13.7%). Stress factors were associated in 28.4% of children. Our findings suggest that LUT symptoms must be investigated carefully at routine pediatric visits.

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“…As part of the Swedish Reflux Trial in Children, a subgroup analysis of LUTD in terms of prevalence, VUR resolution rates, UTI recurrence, and development of renal damage was performed. 35 The authors found that LUTD was seen in 34% of children with VUR, and recurrent urinary tract infections were found in 33% versus 20% of children with and without LUTD, respectively. This study also observed a lower rate of VUR resolution (22% versus 56%), and a much higher rate of renal damage (85% versus 52%) among children with LUTD.…”

Section: Bladder/bowel Rehabilitationmentioning

confidence: 96%

Current management of vesicoureteral reflux in pediatric patients: a review

Weinberg¹,

Hsieh

2013

PHMT

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Vesicoureteral reflux (VUR) is both a functional and anatomic pediatric disorder arising from incompetence of the ureterovesical junction. Some children with VUR remain entirely asymptomatic, while others may develop pyelonephritis, renal scarring, and potentially progressive renal insufficiency. There are still many areas of VUR diagnosis, management, and timing of intervention that remain controversial today. This review attempts to synthesize the best available current evidence from the literature dealing with VUR screening, diagnosis, and treatment in order to provide the practitioner with an organized and evidence-based approach to the disease.

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The Swedish Reflux Trial in Children: V. Bladder Dysfunction

Abstract: After toilet training a third of these children with dilating reflux had lower urinary tract dysfunction, mainly voiding phase problems. Dysfunction was associated with persistent reflux and renal damage while dysfunction at study entry did not predict the 2-year outcome.

Cited by 114 publications

References 21 publications

Acute pyelonephritis in children

Acute pyelonephritis in children

Prevalence of lower urinary tract symptoms in school-age children

Current management of vesicoureteral reflux in pediatric patients: a review

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