SN Wong

Abstract

Recent literature has clarified the relationship of UTI, VUR and renal scarring but their management is still controversial. The overall prevalence of UTI among febrile infants is 5%. For proper management, a firm diagnosis by demonstrating positive cultures of bladder tap or catheterised urine samples is essential. Imaging strategies following a first UTI aim at detecting underlying urological abnormalities, VUR and scarring, but protocols vary. There is general agreement (1) to fully investigate all infants under 1 year and all children with recurrent UTI, and those with abnormal clinical/laboratory features suggestive of urological problems; and (2) not to investigate girls older than five years. In between, the "aggressive" nephrologists investigate all boys of any age, and all children below five years. The "conservative" will do USG+DMSA for these patients, reserving MCU for those with abnormal findings. Among the risk factors for renal scarring, voiding dysfunction and host inflammatory response are two subjects under intensive research. In addition to prophylactic antibiotics, recent trends in management recommend (1) early and prompt antibiotic treatment for any febrile UTI and non-treatment of asymptomatic bacteriuria. (2) looking for and correcting constipation, bladder instability and detrusorsphincter- dyssynergia. (3) doing circumcision for boys with recurrent UTI. The role of ureteric reimplantation has been reviewed by American Urological Association and is summarised.