title: Prevalence of urinary tract infection and vesicoureteral reflux in children with lower urinary tract dysfunction.
abstract: OBJECTIVE
  Lower urinary tract dysfunction is a common pediatric urological problem that is often associated with urinary tract infection. We determined the prevalence of a urinary tract infection history in children with lower urinary tract dysfunction and its association, if any, with gender, bowel dysfunction, vesicoureteral reflux and specific lower urinary tract conditions.
  
  
  METHODS
  We retrospectively reviewed the charts of children diagnosed with and treated for lower urinary tract dysfunction, noting a history of urinary tract infection with or without fever, gender, bowel dysfunction and vesicoureteral reflux in association with specific lower urinary tract conditions.
  
  
  RESULTS
  Of the 257 boys and 366 girls with a mean age of 9.1 years 207 (33%) had a urinary tract infection history, including 88 with at least 1 febrile infection. A total of 64 patients underwent voiding cystourethrogram/videourodynamics, which revealed reflux in 44 (69%). In 119 of the 207 patients all infections were afebrile and 18 underwent voiding cystourethrogram/videourodynamics, which revealed reflux in 5 (28%). A urinary tract infection history was noted in 53% of girls but only 5% of boys (p <0.001). Patients with detrusor underutilization disorder were statistically more likely to present with an infection history than patients with idiopathic detrusor overactivity disorder or primary bladder neck dysfunction (each p <0.01).
  
  
  CONCLUSIONS
  Females with lower urinary tract dysfunction have a much higher urinary tract infection incidence than males. This association was most often noted for lower urinary tract conditions in which urinary stasis occurs, including detrusor underutilization disorder and dysfunctional voiding. Reflux was found in most girls with a history of febrile infections. Since reflux was identified in more than a quarter of girls with only afebrile infections who were evaluated for reflux, it may be reasonable to perform voiding cystourethrogram or videourodynamics in some of them to identify reflux.
authors: Divisions of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian and Columbia University Medical Center, New York, New York.
authors: Jason P
authors: JP
authors: Van Batavia
authors: Jennifer J
authors: JJ
authors: Ahn
authors: Angela M
authors: AM
authors: Fast
authors: Andrew J
authors: AJ
authors: Combs
authors: Kenneth I
authors: KI
authors: Glassberg
mesh_terms: D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D001743:Urinary Bladder / Q000503:physiopathology*; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D014555:Urination Disorders / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D014563:Urodynamics; D014567:Urography; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology
keywords: DO; DUD; DV; EMG; IDOD; LUT; LUT symptoms; LUTS; PBND; PVR; UTI; VCUG; VUDS; VUR; detrusor overactivity; detrusor underutilization disorder; dysfunctional voiding; electromyography; idiopathic detrusor overactivity disorder; lower urinary tract; lower urinary tract symptoms; muscle; post-void residual urine; primary bladder neck dysfunction; smooth; urinary bladder; urinary tract infection; urinary tract infections; vesico-ureteral reflux; vesicoureteral reflux; videourodynamics; voiding cystourethrogram