25 infections per year?!?

Posted by Donna on May 28, 1999 at 14:22:59
My 8 1/2 year daughter has faught repeated UTI and kidney infections since she was 2 weeks old. We have had every test possible to see if there was problem with her structure. When she turned 7 she was diagnosed with a neurogenic-like bladder though it was not there the previous years. We have asked if there could be a small fistula joining her bladder to her intestines. After a VCUG was done, what appeared to be a fistula appeared. A barium enema was done shortly after to see if that would also show this, but it did not show anything. We have been told that a fistula was almost impossible and looking for it would be too difficult. What other reasons would cause a child to have this many infections every year? We are concerned as she can only take a few medications due to an allergy to sulfa drugs. Any help would be appreciated.

Posted by HFHS M.D.-AK on May 30, 1999 at 21:03:19
Dear Donna,
First of all, it would be important to know what types of organisms are causing her infections and does your daughter have reflux..  In regards to the infections, are they the same organism?  Or are they many different types?  If they are the same organism, it would be less likely that a fistula  is present and more likely her neurogenic bladder is not allowing her to completely empty her bladder.  Incomplete voiding allows the bacteria to replicate do to stasis of urine and causes frequent infections.
If your doctor is still concerned about a fistula, the common radiologic study to work -up this problem is a CT scan.  This study not only can look at the bowel and bladder relationship, but may also identify a stone, abscess, or anatomic abnormality not seen on her previous studies.
The VCUG study would identify if she has reflux.  Do to her history of kidney infections, knowing if she has reflex is important.  If she did have reflux, this could be surgically corrected to protect her kidneys.
In my opinion, she needs to have a neurogenic bladder work-up by a pediatric urologist.  This would include a CMG/EMG with a post void residual.  This will give you information on how your daughter