Pediatric Nephrology Specialist Prof. Dr. Mahmut Çivilibal gave information about urinary tract infections in childhood and treatment methods.
Urinary tract infections are more common in girls, except in the first year of life. The most common urinary tract infection (UTI) agent in children is intestinal bacteria. These bacteria settle in the bladder through the urethra, multiply there and then travel from the lower urinary tract to the upper urinary tract (kidneys).
It can develop due to many reasons.
• Urinary system stones
• Voiding disorders
Congenital kidney diseases
•Labial fusion (genital adhesion in girls)
Watch out for these symptoms
Depending on the age of the patient and the location of the infection, signs and symptoms may vary. Urine in the presence of symptoms such as fever, weight gain, vomiting, diarrhea, restlessness, jaundice, foul-smelling urine, weakness, abdominal pain, constipation, change in urination habits (frequent urination, urinary incontinence), painful urination, foul-smelling urine, growth retardation tract infection should be considered. While it may manifest itself with general symptoms such as fever, restlessness and loss of appetite in young babies; In older children, symptoms such as burning during urination, pain, frequent urination are at the forefront. According to the location of the urinary tract infection, if the infection only affected the lower urinary tract and did not reach the kidneys; Painful urination, burning sensation, frequent urination, pain in the groin and urinary incontinence complaints are seen. If there is an infection involving the kidneys; fever, chills, back and flank pain, vomiting, weight loss, deterioration in general condition occurs. There is a risk of kidney damage, especially in patients with urinary tract infections involving the kidneys. For this reason, especially in young children who have febrile urinary tract infections, a rapid diagnosis and appropriate treatment should be initiated, and further investigations should be performed in terms of urinary tract abnormalities.
Care should be taken in collecting urine samples from infants.
Children who come to the doctor with signs or symptoms of UTI are diagnosed by urinalysis and urine culture. For this, the correct urine sample must first be taken. Accurate urine sample collection is provided by taking midstream urine after cleaning the perineum with warm water in older children who have completed toilet training. In small children and infants who do not have urine control, the sample is taken with urine bags for urinalysis. For this, after the genital area is cleaned properly, the urine bag is attached to the genital area.
If the baby does not urinate, it is appropriate to clean and put a new bag every 30 minutes. It is not recommended to collect urine with a bag for urine culture, as urine bags are not sterile and microbes are easily transmitted from the genital area to the urinary bladder, which may cause erroneous results. Instead, if culture is required in young children and infants whose urine control is not yet developed; A urine sample should be taken by entering the urinary bladder with a urinary catheter or by entering the urinary bladder with an injector from the groin area. Taking urine culture with these two methods; It is extremely important in terms of both misdiagnosis and treatment and preventing unnecessary further investigations. Both methods do not have any harmful effects on the baby.
There are many imaging methods in urinary tract infection problems.
Every child with a urinary tract infection should have an ultrasound. Ultrasonography is a very valuable examination method that has no radiation effect and no harm. With this method, detailed information about kidney size, location, tissue thickness, stenosis or obstruction preventing urinary flow, bladder capacity and wall thickness, and urinary tract stones or abnormal structures are obtained. Scintigraphies taken by injecting nuclear material from the vein allow the detection of kidney damage due to previous urinary tract infections and anomalies that impair urinary flow such as stenosis. Voiding cystourethrography, which is popularly described as a catheter film, is used for the diagnosis of vesicoureteral reflux (urine leakage from the bladder to the kidney). These two procedures do not apply to every child with a urinary tract infection. Scintigraphy and/or voiding are performed in children with recurrent urinary tract infections and/or abnormal ultrasound findings. Uroflowmetry (urine flow test) examination is also performed for children with voiding disorder and UTI. The microbe grown in the urine culture is treated with appropriate antibiotics. After the treatment, urinalysis and culture are taken in the control.
Pay attention to these suggestions
•Children should be given the habit of drinking enough water.
• Babies should not be given urination training before the age of 2.5 and pressure should never be applied during training.
•Children should be taught to clean the genital area correctly. Ideally, the genital area should be cleaned from front to back with toilet paper, then the area should be rinsed with water and dried with a paper towel. If cleaning will be done with wet wipes, water-based ones should be preferred.
• By giving the child the habit of voiding regularly, urine should be prevented from staying in the bladder for a long time.
• Especially girls should not wear tight pants and cotton panties should be preferred.
•Boys should be circumcised as early as possible.
•Children should wash their hands before and after entering the toilet.