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Urinary and Genital Disorders (Children)

Confused about recurrent UTIs

10/28/2010

Question:

My 4 year old daughter was diagnosed with VUR when she was 4 weeks old. She had to have a ureter reimplantation surgery when she was 9 months old after having had many UTIs and was showing significant damage to one kidney. The UTIs have been an ongoing problem even though she has been on profalatic antobiotic treatment from the beginning. Most recently we have had several episodes of her waking during the night or early in the morning crying that it hurts her to urinate,frequent and very urgent going as many as 20 times in an hour and only producing a few drops each time. After getting a specimen to the lab the initial results indicated a UTI but the cultures have grown nothing. She is going through this now. On Thurs morning the symptoms started, her urine was very dark. When I spoke to the Dr. she said that there was bacteria and blood in the sample but nothing was was growing after 24 hrs. She has been on a differen antibiotic for 2 days now and the symptoms are starting again. So, my question is, what would be causing her to have almost all of the symptoms of a UTI without having anything grow from the culture?

Answer:

This is a difficult question to answer. Occasionally girls can have symptoms of a UTI with a negative urine culture, and in my experience they respond to a 5 to 7 day course of antibiotics. I assume that the post-operative radiologic studies indicate that there is no reflux and that the kidneys show no hydronephrosis.

It sounds like she may have bladder/bowel dysfunction. These children have infrequent bowel movements, infrequent voiding, urinary frequency with incontinence, or wait until the last second to urinate. We have found that "bladder training" is better than taking a daily dose of an antibiotic. We usually recommend timed voiding every 2 hours during the day, drinking a generous volume of water, and being certain there is a good bowel movement each day. Many children are given a prescription for Miralax, which is a mild laxative that is tolerated quite well in children.

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Response by:

Jack S Elder, MD, FACS, FAAP Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University