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Children UTI outline

 Antimicrobial drugs not enough  underlining cause
 Acquired vs Congenital causes
o Acquired
 Sexual abused
 Urinary Stones – ureteropelvic junction – microscopic
Dysfunctional Voiding Syndrome - lack of coordination between
bladder muscle (detrusor) function and external sphincter activity. Two major
categories of children with dysfunctional voiding are those with "lazy", high
capacity bladders with little sensation and contractile activity, and those with
overactive bladders that lead to frequency and urgency due to poor cortical
control over inhibition of reflex bladder contractions. – secondary VUR
o Congenital  Vesicoureter reflux pyelonephritis renal
scarring/ HTN/ End-stage renal disease
 Ureterocele – Cystic dilation of a terminal ureter- reduces
flow from ureter. Ectopic ureterocele – More common in
children. Orifice opens in the bladder neck  Obstruct the
flow through urethra
 Ectopic Ureters – Duplication of ureter that opens in
ectopic positions – Urinary incontinence
 Boys – bladder neck/ prostate/ epididymis
 Girls – bladder/ urethra/ vagina/ cervix
 Neurologic Bladder – Myelomeningocele/ Traumatic spinal
 Posterior Urogenital Valve - most frequent cause of
congenital bladder outlet obstruction – Only in boys –
Distended bladder/ Bilateral hydronephrosis
Prune-Belly Syndrome - deficiency or absence of abdominal wall
1) deficiency of abdominal musculature
2) urinary tract abnormalities - dilation of the ureters, bladder, and
urethra / Renal dysplasia, pulmonary hypoplasia
3) cryptorchidism
 Urachal Ramnants – Patent urachus – failure of urachus to
obliterate  urine discharge from umbilicus
COMPLICATED UTI – anatomical/ functional underlying
 First Infection
 Recurrent Infection
o Unresolved Bacteriuria - inadequate antimicrobial therapy/
resistance to medications  + same organism  resolve after
right treatment
o Bacterial Persistance - subsequent episodes of UTI of the same
organism despite negative cultures after treatment – catheters/
anatomical malformations  + same organism after
o Reinfection - periurethral colonization or the development of a
urinary tract-gastrointestinal tract fistula  + different
organisms/ serotypes