Urinary tract infection is a common occurence in childhood. The common symptoms are dysuria, urgency, passing of turbid urine, foul smelling urine and pain during micturition in elderly children. In newborns and infants urinary tract infection may present itself with refusal to eat, failure to thrive and gain weight, vomiting, irritability and rarely pyrexia. Fever with urinary tract infection always requires careful evaluation for any underlying condition. The conditions which as physicians we are worried about are vesico-ureteral reflux (VUR) in either sex, and posterior urethral valves (PUV) in male infants. We can rule out the possibility of either by a non-invasive radiological examination called micturating cysto-urethrogram.
Micturating cysto-urethrogram or MCUG as it is properly known, is a simple investigation. In this procedure, a child is laid down on a table in a radiology suite under a camera called a fluoroscope. Then with adequate local analgesia and anesthesia, a fine catheter is gently inserted into his/her urethra (passage for urine). Then a readio-opaque contrast diluted with normal saline is injected into the catheter. Then the catheter is removed. The child is encouraged to pass urine. The image of the kidneys, ureters and bladder is monitored during the process of filling and emptying of the bladder, and a few relevant stat films are taken. The child needs to be gently restrained during the entire procedure as he / she is very apprehensive with a large camera jutting out over his / her face. They sometimes cry out of apprehension but not with pain. We do the entire procedure using proper sterile technique and sterile dressing set. The main risk of this procedure is the introduction of infection which is almost nil in our experience. An important reason of me personally doing this procedure is that previously I have had babies who had to be admitted with severe sepsis following a MCU done outside in reputed institutes but by the radiologist / technicians. The parents should insist that the Pediatric Surgeon who is seeing the child should himself/herself do the procedure or at least supervise the procedure.
Next, if the MCU shows PUV or VUR, they need to be treated accordingly. But there may be few other findings worth interest.
HINMAN SYNDROME / NON NEUROGENIC NEUROGENIC BLADDER - Sometimes we find chronically distended bladder with trabeculations but no organic pathology. These children retrospectively are found to suffer from chronically holding urine. They seldom pass urine for the duration that they are at school, the reason being untidy bathrooms. These children respond well to double voiding and timed voiding.
CHRONIC CONSTIPATION - Some children are chronically constipated. The loaded rectum, in turn causes inadequate voiding and lead to recurrent urinary tract infection. These kids often improve after their constipation is treated.
TO CONCLUDE, WHENEVER YOU SUSPECT YOUR CHILD TO HAVE URINARY TRACT INFECTION, NEVER START TREATMENT / ANTIBIOTICS UNTIL YOU HAVE YOUR CHILD'S URINE TESTED.
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