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Wednesday, June 19, 2013
Urinary and Genital Disorders (Children)
My 6 year old son has had two proteus uti in 4 months (no fever). He was tested for reflux as a neonate and had a DMSA, everyrthing is normal. He also has yearly ultrasounds as well as blood and urine tests and they are all fine. I have scheduled an ultrasound in 20 days. A nephrologist i consulted wants to start chemoprophylaxis until the ultrasound (20 days). His pediatrician wants to repeat a urine culture ten days after the last dosage of antibiotic (cefuroxim) and wait for the ultrasound. She says chemo is unnecessary. He has a new baby brother and keeps soiling his pants with pee and poo. What should I do?
This is a difficult question to answer, as there are several confusing aspects. First, it is unclear why he was tested for reflux as a neonate. Did he have a UTI as a newborn? Did he have prenatal hydronephrosis? Also, why is he having yearly ultrasounds, and blood and urine tests if they are always fine? Proteus UTIs are pretty uncommon, particularly in boys. However, fortunately he did not have fever, which would have been a sign of kidney involvement. Is he uncircumcised? If so, can he retract his foreskin completely? When he gives the urine sample, is the foreskin retracted? Boys who are uncircumcised may have bacteria that colonize the foreskin and are more likely to get a UTI compared with boys who are circumcised. In addition, sometimes urine samples are contaminated in uncircumcised if the foreskin is not retracted when the sample is provided.
I assume he had symptoms of burning, frequent urination, and suprapubic pain, which are symptoms of a bladder infection. Also, he has symptoms of bladder/bowel dysfunction. It sounds like he has constipation and would benefit from treatment with a laxative, such as Miralax. At any rate, I do not think he would benefit from antibiotic prophylaxis, because he is not getting kidney infections. In addition, most probably his ultrasound will be unchanged compared with his previous annual studies. Finally, he might benefit from evaluation by a pediatric urologist.
Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University