UTIs

[G'sMommy]

Hi,

My son is 15 months old and he is not circumsized. He has had two UTIs and we are trying to figure out what is causing them. We do not pull back his foreskin to clean him. Some doctors tell us we should, others tell us we don't have to. He had follow-up tests including a VCUG and a renal ultrasound and they both came back normal. Is anyone else dealing with this? Do you have any suggestions for what the cause of the UTIs could be?

Thanks,
G's Mommy

[Quirky]

Could it be that the bacteria he's getting is resistant to the antibiotics used? Has he had a culture done of his urine to determine what the bacteria is and what it will respond to?

I had a couple UTIs during my last pregnancy (when I'm more vulnerable to them anyway). The second one was likely just a continuation of the first; the first antibiotic beat it back but didn't get rid of it altogether. When I had the second one, my midwife sent my urine for a culture and prescribed a stronger antibiotic.

The alleged UTI/foreskin link has been thoroughly discredited. Circing your son won't guarantee he will never get another infection. Here's more info on that just in case anyone brings it up: http://www.nocirc.org/statements/breastfeeding.php (see the sidebar).

Nor should you retract him for cleaning. That is totally against the recommendation of the AAP and will only introduce pathogens into the area, not to mention cause bleeding, pain, and scarring that could lead to the need for a circumcision later on in life. The foreskin shouldn't be retracted for cleaning in infancy - the only person to retract the foreskin should be the child himself when he is ready.

I would definitely ask for a urine culture and I would also get vitamin C in the form of sodium ascorbate and cranberry extract into him. You could either see if he will drink some cranberry juice or get the cranberry extract capsules, open them up, and stir the powder into some applesauce or yogurt or something. Blueberries are also excellent for combatting UTIs, and very palatable to young kids - I buy frozen blueberries and defrost them for my son.

Good luck, and make sure any doctors you consult don't either a) blame his foreskin for the problem or b) tell you to retract it or cut it off! If they do, find another doctor as they are obviously ignorant.

[Frankly Speaking]

It seems like you have done all of the right things so far, especially if it can be ruled out that the two incidences were two separate infections that were cured and not the same one that was beat into temporary submission with antibiotics. Most children will grow out of UTIs by the time they are about a year old so this may be only a temporary problem that will not return.

But, let me ask one thing. Did you breast feed? Breast feeding has a simply amazing effect against UTIs. That's because your body is protected by beneficial bacteria that ward off UTIs and by breast feeding, you transfer that immunity to your children. AT birth, they do not have this immunological function and have to attain it and build it. Breast feeding just jump-starts the building of the immune system. If you didn't breast feed, take some time with your son to get skin to skin contact with him and with as much of his body as you can make contact with. This will transfer your immune system to him.



Frank

[Quirky]

Great point on the probiotics (beneficial bacteria). It would be a very good idea to feed him yogurt with live, active cultures (like Stonyfield Farm) every day, both to help colonize him with the good bacteria and to help build up his gut from the beating from the antibiotics. You can also find probiotics powder for babies in the refrigerator section at Whole Foods or your local health food store, and you can stir this into yogurt/apple sauce/any pureed food or beverage to get it into him.

[Fi.]

I second the yogurt/probiotics suggestion.

As far as the UTIs go, some people (circumcised OR intact) are just prone to them. I had a (circumcised) partner years ago that had them all the time.

[shaylahc]

I agree that some people are just prone to them. I would also ask for a follow up with a pediatric urologist, just to make sure nothing is being overlooked.

I DO have 1 child with Reflux, so it runs in our family. When our DS was 5 weeks old he got his very first UTI. I was 100% certain it was due to reflux (since it runs in the family) but to our surprise our DS' VCUG came back normal. The only abnormality was some mild hydronephrosis on his ultrasound. My DS is 13 mos old and has never had another UTI.

The other thing that comes to mind is the possibility of a very low grade reflux. It is unusual, but not unheard of, for a child to have a negative VCUG and then go on to have a positive one. Human error, or extremely low grade reflux can cause a false negative.

Any child who is prone to UTIs may benefit from antibiotic prophylaxis. That is why I would insist on a consult with a pediatric specialist, and let them answer all your questions.

[G'sMommy]

Hi,

I am a new member so please excuse me for posting a new thread instead of continuing with my original one about UTIs.

Thank you all for all of your feedback. I did nurse my son until he was 9 1/2 months old. He eats lots of yogurt. I will pick up some frozen blueberries and cranberry juice for him.

When my son had his VCUG and renal ultrasound, one of his nurses completely retracted his foreskin to obtain a clean urine sample. Do you think this did any damage/scarring?

Thanks!

[Frankly Speaking]

If he wasn't already retractile, yes, there was damage. However, usually, one case of forcible retraction does not cause significant damage. How did your son react to this?


Frank

[hummingbear]

Originally Posted by G'sMommy

Thank you all for all of your feedback. I did nurse my son until he was 9 1/2 months old. He eats lots of yogurt.

Just make sure it is a yogurt that has a lot of live culture, many of them don't.

Originally Posted by G'sMommy

When my son had his VCUG and renal ultrasound, one of his nurses completely retracted his foreskin to obtain a clean urine sample. Do you think this did any damage/scarring?

Oh how I hate hearing this one. Yes some damage but how much you will need to have patience to find out - maybe until maturity. And yes it may (most probably) heal perfectly well on its own. No you do not need to retract to clean after he has been forcibly retracted though many medical prefessionasl will tell you this. My sister's son was forcibly retracted when cathed for a UTI. Circumcision, retraction for cleaning, and steroids were all suggested. After reading nocirc and other sites she refused these suggestions. Yes once forcibly retracted another UTI may be more likely. Good that tests returned normal. My sister knew before the birth that there were urinary system abnormalities and so their path was much more complicated however her DS is still intact. One of her doctors admitted that intactness had nothing - no nothing to do with why her son had a UTI. Beware, if retraction occurs in the hospital there may have been an antibiotic resistant strain introduced. This was the case with my sisters son. They cultured for the specific pathogen and the doctor said the only place he could have aquired it was in the hospital (he had some extensive hospital stays). The antibiotic he needed to get rid of it was so strong that he had to have 10 days hospital stay on IV to get rid of it. Just keep you eye out for future UTI symptoms. Sister's son had a minor infection when an adhesion from the forced retraction seperated when her DS pulled on himself really hard. It was very quickly and easily treated, with her alert eye and understanding.

to you