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Urology (Expert Forum)
12 month old with Chronic UTI's, no VUR
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
12 month old with Chronic UTI's, no VUR
by surfergirl222, Jan 31, 2006 12:00AM
My 12 month old daughter had her first UTI in Oct. She then had a renal u/s and VCUG. Her VCUG showed no reflux. The only abnormality was that in both her renal u/s and VCUG her bladder was distended. Also after they took out her catheter during the VCUG she had residual urine. She only urinated 10-20% of it. They then let her go again and she peed about 50% more of her bladder.
We were then referred to a ped. urologist. He told us that her distended bladder in her ultrasound was probably b/c she "had to pee" and that she probably didn't empty her bladder fully and had residual urine b/c of the trauma of the catheter. He then referred us for a DMSA scan. (She remained on prophylactic antibiotics)
Her DMSA scan came out normal. No kidney scarring, no reflux. In the meantime, on the prophylactic antibiotics she got ANOTHER UTI! That one took a very long time to get rid of (over a month), we had to try 2 different antibiotics and she also had to have 2 huge antibiotic shots before she got rid of it.
Our ped. urologist now says that everything is normal and there is nothing else he can do and we should now be treated by her regular ped now. Does that sound right to you?
Isn't there anything else it could possibly be? Shouldn't they at least repreform the ultrasound to see if her bladder is STILL distended? (I should add the u/s was done at a small local hospital and not even a childrens hospital so I'm wondering if they could have missed something too).
Should I get a second opinion? Or b/c her other tests have come out normal and she has no VUR is there really nothing else they can do. Our ped. urologist recommended taking her OFF of the prophylactics too. I am also unsure of that since she already had one breakthrough infection on them.
Is this appropriate? Did he miss something? Or is this just something my daughter is going to have to live with? We are VERY careful and prompt with diaper changes, etc. She gets so sick when she gets her UTI's and gets such bad flank pain she falls to her knees when she walks.
Oh, and if we get a 2nd opinion the only ped. urologists around here are at the Childrens Hospital - where our original urologist was. Is it ok to use another Dr. in the same dept, or will we be laughed at as hypochondriacs?
Any advice or ideas would be GREATLY appreciated!
Linda
We were then referred to a ped. urologist. He told us that her distended bladder in her ultrasound was probably b/c she "had to pee" and that she probably didn't empty her bladder fully and had residual urine b/c of the trauma of the catheter. He then referred us for a DMSA scan. (She remained on prophylactic antibiotics)
Her DMSA scan came out normal. No kidney scarring, no reflux. In the meantime, on the prophylactic antibiotics she got ANOTHER UTI! That one took a very long time to get rid of (over a month), we had to try 2 different antibiotics and she also had to have 2 huge antibiotic shots before she got rid of it.
Our ped. urologist now says that everything is normal and there is nothing else he can do and we should now be treated by her regular ped now. Does that sound right to you?
Isn't there anything else it could possibly be? Shouldn't they at least repreform the ultrasound to see if her bladder is STILL distended? (I should add the u/s was done at a small local hospital and not even a childrens hospital so I'm wondering if they could have missed something too).
Should I get a second opinion? Or b/c her other tests have come out normal and she has no VUR is there really nothing else they can do. Our ped. urologist recommended taking her OFF of the prophylactics too. I am also unsure of that since she already had one breakthrough infection on them.
Is this appropriate? Did he miss something? Or is this just something my daughter is going to have to live with? We are VERY careful and prompt with diaper changes, etc. She gets so sick when she gets her UTI's and gets such bad flank pain she falls to her knees when she walks.
Oh, and if we get a 2nd opinion the only ped. urologists around here are at the Childrens Hospital - where our original urologist was. Is it ok to use another Dr. in the same dept, or will we be laughed at as hypochondriacs?
Any advice or ideas would be GREATLY appreciated!
Linda
Doctor's Answer
by Kevin Pho, MD, Feb 01, 2006 12:00AM
, Feb 01, 2006 12:00AM
It is never unreasonable to obtain a second opinion if the diagnosis is unclear. In this case, I would certainly consider one - just to be sure.
You are correct to assume that VUR should be suspected in any cause of a UTI in an infant. To rule this out, and other anatomic abnormalities, the VCUG and ultrasound were appropriately ordered.
Other imaging tests can be considered if the diagnosis is non-revealing. This can include radionuclide cystography (RNC) - although the VCUG is the better test.
Another option would be renal cortical scintigraphy (with 99 m Tc-DMSA or 99 m Tc-glucoheptonate) and enhanced computed tomography that can be used to identify renal scarring and acute changes due to pyelonephritis. Scintigraphy is a more sensitive test than ultrasound.
If the tests continue to be negative, periodic monitoring with serial ultrasounds and/or VCUGs can be considered and discussed with your personal urologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
You are correct to assume that VUR should be suspected in any cause of a UTI in an infant. To rule this out, and other anatomic abnormalities, the VCUG and ultrasound were appropriately ordered.
Other imaging tests can be considered if the diagnosis is non-revealing. This can include radionuclide cystography (RNC) - although the VCUG is the better test.
Another option would be renal cortical scintigraphy (with 99 m Tc-DMSA or 99 m Tc-glucoheptonate) and enhanced computed tomography that can be used to identify renal scarring and acute changes due to pyelonephritis. Scintigraphy is a more sensitive test than ultrasound.
If the tests continue to be negative, periodic monitoring with serial ultrasounds and/or VCUGs can be considered and discussed with your personal urologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
Member Comments (1)
by surfergirl222, Jan 31, 2006 12:00AM
To: Pediatric Urology
0
