Urinary Tract Infections
What are they? Urinary Tract Infections or UTIs are bacterial infections of the bladder and the kidney. When the bladder alone is involved, it is called cystitis. When the kidneys are involved exclusively, it is called pyelonephritis.
Why do they occur? UTIs are more common in girls because the opening to the urinary tract called the urethral opening (where the urine comes out) is in the middle of the vagina which is filled with many germs. Certain germs called fimbriated germs actually walk up the urethra into the bladder. In boys, where the urethral opening is at the tip of the penis, it is more difficult for germs to climb in.
What are the symptoms? UTIs are almost always associated with painful urination and accidents. The reason is that when the bladder is infected, it goes into spasm more easily. The spasm is associated with pain as well as the unexpected emptying of the bladder (an accident). In addition, there is often urgency (the feeling that you have to constantly urinate) and frequency (actual frequent urination).
What can be done? The treatment for a UTI is oral antibiotics. Typically, antibiotics such as Bactrim or Augmentin are used although for teens, Cipro is often the first antibiotic of choice. In boys, we often will do two additional tests after even the first UTI. Because up to 5% of UTIs are associated with anatomical abnormalities of the urinary tract, it is important to make sure that this first UTI doesn’t mean there is a fixable problem of the urinary tract. The two tests to be done are a renal ultrasound which is a non invasive picture of the bladder and kidneys (similar to the prenatal ultrasound that all women routinely get), and a VCUG or vesico-ureteragram where some dye is inserted in the urethra and we test for reflux or the passage of urine up to the kidneys as well as down outside the body. The VCUG test is obviously invasive and is often done under light sedation in the hospital. In girls, we typically will do a renal ultrasound in children under age 6 with the first UTI and then do the VCUG if there is a second episode.