Imaging the urinary tract in children with urinary tract infection
ABSTRACT To evaluate whether ultrasonography (US) alone is sufficient in imaging the urinary tract in 1185 children with urinary tract infection (UTI).
The reports on US and voiding cystourethrography (VCUG) were reviewed.
Initial US was normal in 861/1185 patients (73%). VCUG revealed abnormal findings in 285/861 (33%), of which grade III-V vesicoureteral reflux (VUR) comprised 97 cases (11%). During follow-up, VUR had resolved in 88/97 (91%) patients: in 50/57 (88%) patients without active treatment for VUR, in 27/29 (93%) with endoscopic and in 11/11 (100%) with open surgery for VUR. During follow-up, 11/97 patients (11%) had developed new renal scarring detectable in US, but no renal impairment occurred. Except for VUR, VCUG showed nonobstructive urethral valves in two infant boys with normal initial US. Thus, in 861 children with normal initial US, 40 patients with grade III-V VUR and two patients with significant nonreflux pathology may have benefited from surgical treatment, giving the total number of possibly missed pathological finding in 42/861 (4.9%) cases if VCUG had not been performed.
We suggest that children with UTI could be examined using US alone and to use VCUG only after additional indications.
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ABSTRACT: It has been suggested that biofilm formation by uropathogenic Escherichia coli (UPEC) isolates is associated with recurrence and persistence of urinary tract infection (UTI). We compared the in vitro biofilm formation of UPEC isolates from children with acute or recurrent UTI. Employing 206 consecutive clinical UPEC isolates from children with proven UTI, i.e., pyelonephritis (n = 78), recurrent pyelonephritis (n = 10), cystitis (n = 84) or recurrent cystitis (n = 34), we applied 1 % crystal violet staining to polystyrene microtitre plates at 72 h and measured the optical density (OD) values. The method had been validated to measure biofilm formation against confocal laser scanning microscopy and scanning electron microscopy. The OD values were lower in the recurrent cystitis group than in the other groups (mean OD 0.36, SD 0.21 vs mean 0.47, SD 0.36, P = 0.04) and higher in the recurrent pyelonephritis group than in the other groups (mean OD 0.69, SD 0.33 vs mean OD 0.44, SD 0.34, P = 0.006) indicating biofilm formation of strains causing recurrent pyelonephritis. It appears that the properties of UPEC isolates required for effective biofilm growth on an abiotic surface are important for recurrent pyelonephritis, but not for recurrent cystitis. It would be valuable in the future to analyze whether the biofilm properties of E. coli observed in vitro predict a slower clinical response to antimicrobial treatment and increased renal scar formation after UTI.European Journal of Clinical Microbiology 09/2013; DOI:10.1007/s10096-013-1935-4 · 2.54 Impact Factor
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ABSTRACT: To estimate the subsequent cancer risk of children receiving post voiding cystourethrography (VCUG), a nationwide population-based retrospective cohort study with the data from the Taiwan National Health Insurance Research Database (NHIRD) were used for the analysis. In the VCUG cohort, 31,908 participants younger than 18 years of age who underwent VCUG between 1997 and 2008 were identified from the NHIRD. A comparison cohort, the non-VCUG cohort, was randomly selected among children without VCUG examination histories during 1997-2008, frequency matched for age (every 5 years), sex, geographic region area, parents' occupation, and index year based on a 1:4 ratio. Cox's proportional hazard regression analysis was conducted to estimate the subsequent cancer risk of children receiving VCUG. The overall cancer risk of the VCUG cohort is 1.92-fold (95 % CI = 1.34-2.74) higher than that of the non-VCUG cohort with statistical significance. The genital cancer and urinary system cancer risks of the VCUG cohort are respectively 6.19-fold (95 % CI = 1.37-28.0) and 5.8-fold (95 % CI = 1.54-21.9) higher than those of the non-VCUG cohort with statistical significance. The hazard ratios are higher in genital cancer, urinary system cancer (the major radiation exposure area), and cancer of the abdomen, except for the genitourinary system (the minor radiation exposure area), in sequence. Pediatric VCUG is associated with increased subsequent cancer risk, especially in the genitourinary system.Pediatric Nephrology 12/2013; 29(5). DOI:10.1007/s00467-013-2703-5 · 2.88 Impact Factor
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ABSTRACT: To evaluate the accuracy of renal and bladder ultrasonography (RBU) in predicting vesicoureteral reflux (VUR) in infants and children. A total of 134 children who had VUR demonstrated on voiding cystourethrography (VCU) and also had RBU within 1 month of the VCU were included in the study, which took place between January 2005 and December 2012. VUR and hydronephrosis were graded with standard methods on VCU and RBU, respectively. Using VCU findings of reflux as the gold standard, diagnostic accuracy measures were performed for hydronephrosis and ureteral visualization on RBU, including sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Reflux grade was significantly associated with the degree of hydronephrosis (P = .0032). The sensitivity, negative predictive value, and accuracy of ultrasonography in predicting reflux was significantly higher for grade IV+ or grade V reflux compared with lower reflux grades. Also, the specificity of ultrasonography in predicting reflux was constant and at high level across all reflux grades, suggesting that ultrasonography is a good diagnostic screening tool. Normal RBU is rare with grade IV-V reflux, and moderate to severe hydronephrosis is rare with reflux grades <IV. RBU is a valid screening test for the selection of patients with a first urinary tract infection who should undergo VCU. Diagnosis of grade IV and V reflux will be delayed in very few cases, using a definition of abnormal RBU to include all degrees of hydronephrosis (Society for Fetal Urology classification). Copyright © 2014 Elsevier Inc. All rights reserved.Urology 11/2014; 84(5):1205-10. DOI:10.1016/j.urology.2014.06.057 · 2.13 Impact Factor