Agggh UTI

[gamom]

We have, well my ds has an UTI. He is 15 months old. I posted a few weeks ago about him "straining" to potty. Anyway earlier this week he had a dry diaper for over 6 hours which is unheard of for us so I took him to see is doctor. Anyway, he was bagged for a urine sample, we got one but he also had a BM too. Well, the sample was cultured and it grew over 100,000 colonies of a bacteria called proteus miravilas. I was told this might have been because of bm getting under his foreskin and was also told that he MIGHT need to be circ'ed. But for now they want to treat him with antibotics and do a kidney workup. They want to do an ultra sound of his bladder and a VCUG (voiding cystourethrography) a tell where they insert a small tube in the penis and inject a dye to see if there are any abnormalities and if he has reflux. Anyway, I am ok with treating the UTI with antibotics but I am not sure if it is necessary for this other invasive stuff. Has anyone had a young son who has had a UTI and something like this was suggested? Am I over reacting...oh and by no means is my son getting circ'ed because he has had ONE UTI!!

Oh I took ds back to the doctor today to ask for a repeat urine culture thinking the other might have not been a clean catch because of the presence of stool....but was told that it would probably be negative because ds had been on antibotics for a few days and that there is no harm in getting the tests to see if there is any problems going on. ds is waking, i think i got all the highlights in though

[mattemma04]

My ds is 2.5 and not had any infections yet. Personally I would agree that beyond the antibios the other things are rather invasive considering this is the first infection. I would opt out of everything until(and if) another infection or 2 occurs,but get it swabbed before getting invasive tests done.Why traumatize an area that just had to deal with infection? It is going to possibly cause another infection,and thus create a *need* for circumcision.

My ds sometimes gets poop all over his penis,and maybe some gets *inside*,but it would seem rather foolish to me to expose the glans to urine and fecal matter by circumcising. I suppose their reasoning is that you can easily wash off the dirty stuff once you cut off the covering skin.

I would find a less invasive doctor,and one that does not throw around the *C* word with every male genital issue that comes up.. I understand they are just *covering bases*,but anytime you stick something inside you risk infection and trauma to that area. Best wishes and speedy healings for your son! It is perfectly ok to say no thanks for the other tests.

Oh and I wonder if they are this invasive with circed boys that get UTIs?

How in the world are they treated to prevent UTI since they are already circed?????? Something to ask at the follow up visit!

[acrathbun]

well, I think your ped is "out there" even bringing up circ. However, the ultrasound & the VCUG aren't terribly invasive and if your child does have kidney reflux (my Sarah does) believe me you would want to know. Undiagnosed/untreated kidney reflux can seriously damage the kidneys & often a UTI is the only/first sign.

SO, if it were my child I would def. do the ultrasound & the VCUG, but I would also def. nix the circ idea right away. I don't think UTI is *ever* a reason to circ.

[Frankly Speaking]

We had a similar story here a couple of months ago . . . A UTI in a very young intact boy with the same diagnosis and prescription. The Mother came here with her story and then found a world famous nephrologist (kidney specialist) in Boston. She flew with her son from Oklahoma to Boston to see this specialist and he told her that doing a VCUG test after a single episode would be "cruel treatment" and strongly recommended against it. She took his advice and did nothing. As far as we know, her son has had no more episodes.

Young children are at a greater risk of UTIs and as they get older, get an immunity to them. A single episode of UTI is not an indication for anything more than an antibiotic treatment. Most likely, if your son had been circumcised, you would not have gotten this prescription. Contrary to popular belief, if there is any difference in the UTI rates of circumcised and intact boys, it is only a fraction of a percent. Certainly not enough for any difference in the treatment regime.



Frank

[gamom]

In fairness to the doctor she didnt mention circ until my mother asked her the question. She then said research says that intact boys get UTIs more than circ'ed boys. She also said that she would recommend those test for any boy who presented with an UTI because of the possibility of renal reflux. So how common is renal reflux?

[gethane]

My son had a UTI at 6 months old and spent a few days in the hospital on IV antibiotics. The doc suggested the u/s and the vcug and we did go ahead and have it done. It was negative, but I did feel better knowing.

[zaftigmama]

My best friend's daughter recently had a UTI. Her ped. recommended the dye test (I forget the name but it's the VCUG) and my friend looked into it and got a second opinion. Luckily she's a nurse and her dh is a surgeon, so they had easy access to medical advice. We have a mutual friend who has a son who has had repeated UTI's and she asked her advice as well.

Most dr.'s advised (strongly) against the dye procedure after 1 UTI. The majority opinion was that it should be reserved for patients with a family history of bladder irregularities, or with 2 or more UTI's in a six month period.

Worse,a few dr.'s made comments like, "You're lucky she's a girl or you'd be hearing you have to get her circumcised." Many dr.'s said that circumcision is often the first suggestions dr.'s will give when a boy presents with the presence of bacteria. They were also told the procedure was slightly more invasive for a boy.

Our friend's son has been through the procedure and said it is painful, long and invasive. She advised to finish the antibiotics and see if there was a recurrence of infection before subjecting her child to the procedure.

In the end my friend did bring her dd in for the ultrasound and nothing was found. There hasn't been a recurrence, and the dr. is blaming the infection on bubble bath.

I would get a second opinion, but just having been through it with a friend (I know that sounds dumb, but you know how when a close friend has a problem and you talk about it all the time, it almost feels like it was your own problem?) to not have an invasive procedure done on the basis on 1 infection.

Good luck!

[shelbean91]

My doc recommended the u/s and vcug for my dd after she had 2 uti's in about 18 mos and I supected a 3rd. Turned out she didn't have a 3rd and hasn't had 1 since. We didn't do the u/s or vcug b/c I knew (thought) the UTI's were caused by MIL not wiping thoroughly from front to back and dd staying in a dipe too long. These happened around the time dd decided she was too busy to get a dipe change, so wouldn't tell us if she was wet.

I understand Amanda's point of if something is wrong, you want to find out, but one UTI doesn't mean there is reflux. I would wait and see if the UTIs become a pattern, personally. And next time the doc recommends circ for a UTI, ask him/her if that woudl be the same recommendation for a girl and if not (of course it's not), you want to follow the treatment they would prescribe for a girl.

[gamom]

Thanks gethane, shelbean91 and zaftigmama for the situations. Now that I have read up on renal reflux I am almost too scared not the have the tests done. I would feel so bad if he had another UTI a few months down the road and then got the tests and was refluxing the entire time..its so hard to decide what is best at this point..I am not sure. But not to worry no matter what path I decide to take no one will talk me into circumsion! I guess his penis would have to fall off first :-)

[karlatrx]

I have a daughter with severe hydroneprosis due to a blocked ureter. We've been through those tests before too.

In my (unprofessional) opinion, I would choose to go for the ultrasound and skip the VCUG for now. The ultrasound isn't invasive and will let you know if hydronephrosis, scarring, or cysts are present and could give you some peace of mind. If there are abnormalities then a VCUG would be a good idea. If the ultrasound is normal and there's only been one UTI a VCUG would imo be overkill. From what I've read VCUG's are usually only suggested after recurrent UTI's not after a single infection.

Whatever route you choose I hope everything is okay.

Here's a bit of advice for anyone whose child has to have a VCUG. If both you and your partner are there they'll probably have one of you stay with the child and the other go into the control room. Choose to go to the control room. #1 you protect your eggs from the radiation in the room (low amount, but still it's continuous) #2 seeing the video display of the VCUG is so awesome. It's got to be one of the coolest things I've ever seen. You can see bones and internal organs as they move.