Bladder dysfunction and recurrent urinary tract infections in children

Elisabeth Hodson

Centre for Kidney Research, The Children's Hospital at Westmead Westmead, NSW 2145, Australia

Population-based studies show that 8% girls and 2% boys have one or more documented urinary tract infections (UTI) by age 8. Among children with their first UTI after the first year of life, the recurrence occurs in a third to a half of children. The risk of recurrence increases with the number of preceding infections so that girls with 3 previous UTIs have a 75% risk of recurrence. Daytime incontinence with other symptoms of bladder dysfunction is common and causes considerable distress to the child and his/her family. In Australia 4% wet twice or more each month and 1% wet once or more each day; 4% children have both day and night wetting. Many children with recurrent UTIs have bladder dysfunction though the exact relationship between these conditions is unclear. In some children, symptoms of bladder dysfunction develop after the first UTI while in others UTIs occur where bladder dysfunction is already present. Symptoms of bladder dysfunction include day-time incontinence, urgency, squatting, frequency, hesitancy and intermittent urine stream. Many also have constipation and faecal soiling. Bladder emptying difficulties occur more frequently in girls, with a history of UTI. In assessing a child with recurrent UTIs, a detailed history of voiding patterns is essential. Additional information is obtained from frequency-volume charts of intake and output (voiding frequency and functional bladder capacity), ultrasound (bladder emptying) and Uroflow studies (voiding patterns). Other investigations of the urinary tract are rarely required unless the child suffers febrile UTIs or bladder function fails to improve with treatment. Management remains controversial and its efficacy has not been documented in randomised controlled trials. However successful treatment of bladder dysfunction with bladder training or anticholinergic agents have been associated with reduced number of UTIs. In our clinic management comprises a full explanation to the child of how the kidneys and bladder work and how he/she can control bladder function together with increased fluid intake, treatment of constipation, antibiotic prophylaxis, cognitive bladder training and anticholinergic agents.

Invited lecture at the 6th annual convention of Pediatric Nephrology of the Philippines, Manila, July 2001

Correspondence
Elisabeth Hodson
ElisaH@chw.edu.au