Urinary Tract Infections in
Children with Neurogenic Bladder
and Bowel
Kristina D. Suson, MD
Pediatric Urologist
Children’s Hospital of Michigan
Why does a urologist care about
neurogenic bladder and bowel?
• Protect the kidneys!
– Prevent urinary tract infections
– Identify/treat vesicoureteral reflux
(VUR)
– Keep bladder pressures low
• Help promote continence
How do I know my child has a UTI?
• Infant
–
–
–
–
–
–
–
Fever
Fussiness
Lethargy
Bloody urine
Change in urine quality
Vomiting
Decreased appetite
• Child
– Fever
– Vague
discomfort/complaints
– Change from usual
activity
– Increased leaking
– Change in urine quality
– Nausea or vomiting
– Decreased appetite
Preventing Urinary Tract
Infections
• Clean intermittent catheterization
• Bowel management
– Constipation leads to increased stool in rectum
– More stool in rectum = more bacteria on
perineum (the place between the anus and the
urethra)
– More bacteria near urethra leads to infections
• Prophylactic antibiotics (low daily dose)
• Bladder washes
What is vesicoureteral reflux
(VUR)?
• VUR is when urine goes from bladder
to kidneys
• If bacteria in bladder and child has
VUR, risk of kidney infection
• Bladder infections are a nuisance, but
kidney infections can decrease kidney
function
How do I know my child has VUR?
Voiding Cystourethrography
(VCUG)
• Screening at birth
• Urinary tract infection
with a fever
• New hydronephrosis, or
swelling of the kidney
Outline of the kidney, as
it appears on ultrasound
Dark portion in middle =
hydronephrosis, or
inappropriate build-up of
urine in the kidney
VCUG
If bacteria are in
bladder, can cause
kidney infection
Urine
traveling up
ureter to
kidney
Bladder
outpouchings, or
diverticula,
consistent with
neurogenic bladder