A practical approach to evaluating urinary tract infection in children

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Abstract
After a first urinary tract infection (UTI), all children require an evaluation with imaging studies to screen the urinary tract for anatomic abnormalities and for reflux. Ultrasonography and voiding cystography readily accomplish this and are recommended, knowing that such a recommendation is controversial. While the likelihood for reflux-induced renal damage is age related, the presence of reflux in any child with infection is clinically important for management. Abnormal screening results or recurrence of infection warrant further radiographic testing. However, imaging studies are necessary but do not constitute sufficient evaluation for UTI because the etiology of infection is only rarely identified with these tests. Sorely neglected in most recommended protocols for evaluating urinary infection is an investigation for micturitional disturbances which may be responsible for the infections. Treatment of these conditions may actually prevent recurrence of infection. Controversy surrounding the proper imaging evaluation for UTI appears to be misdirected. Instead of arguing about which imaging study should be performed or which child with a first UTI should have a cystogram, our patients might be better served if we wondered why traditional protocols for evaluating UTI deal only with imaging studies.