UTI in intact 19mo

[junebugmidwife]

Hi, not sure if this is the right forum, but here we go:

DS was diagnosed with his first UTI this past Monday (by me!) after a few days of crabbiness and then when it escalated to crying, grabbing his crotch and smelly urine I figured it out! Seems so clear in hindsight. Anyway, the prevailing wisdom in yound kids with a UTI is to do a VCUG, where they put contrast dye in the bladder via a catheter to see if the dye spills into the kidneys (it shouldn't); this is because apparently many kiddos with UTIs have it because of a structural abnormality. Clearly, this is an invasive test. I am not sure that I want to do that and am currently planning to closely monitor him via follow-up urine testing. I know I could identify a UTI a lot faster if it recurred, now that I've seen one. If he did have another UTI, I would definitely go for the VCUG, since then the 'what if this is a one-time thing?' idea will be discredited. The real concern with repeated UTIs that go undetected is that the kid could get kidney damage.

Anybody else with this experience? Advice?

[Marsupialmom]

If this is his first UTI I would review things, Like soaps and detergents.

Also why not just an U/S first? I know with boys UTI's ussually a sign of something else not structurally right but I wouldn't jump to a VCUG. At least not the first UTI at 19mnths.

[joandsarah77]

Sorry your little man has that What does VCUG stand for? Did the Dr give him some antibiotics? I think if my ds had an uti, then had another one closly folowing, then I'de go see about the test. Hope he gets better soon.

[Frankly Speaking]

A VCUG test is not indicated after a single episode of UTI.

We had a mother from Oklahoma here about a year ago whose son had two episodes of UTIs. She was very concerned and ended up flying her son to Boston to see a world famous nephrologist. (Kidney specialist) He told her that a VCUG test was not advised until the third episode. He felt it was unnecessarily invasive to do it before then and I agree with him.



Frank

[MCatLvrMom2A&X]

My dd had her first and only uti at around 15-18months old the dr recommended the VCUG well he basicly scared the crap outta me no one wants there child to have permanant kidney damage so I took her and had the test done. It was one of the most horrible experiances I have been thru with her she already had eczema on her little bottom and the dye made it so much worse, I was so scared she would be allergic to the dye, but she wasnt thank God, they assured me should a reaction occure they were ready for it.

Having said all that if I had it to do over again I would wait and see if she got anouther UTI then had the test if she did. I dont think I would wait for 3 times but that is just my opinion. If ds ever gets a UTI I will not have the test done right away I will wait and see.

Up until recently I had never had a cathiter and I had no idea how much those things hurt, now that I know that also plays a part in my decision.

[Frankly Speaking]

Originally Posted by MRDCatLvr

It was one of the most horrible experiances I have been thru with her she already had eczema on her little bottom and the dye made it so much worse,

Up until recently I had never had a cathiter and I had no idea how much those things hurt, now that I know that also plays a part in my decision.

Melissa, thanks for kick starting my brain! It makes me wonder why they are so quick to order up this invasive, painful and expensive test when they seldom do a simple, quick, cheap and about as painful and invasive as a bottom wiping, culture to confirm an infection? It makes absolutely no sense to be so quick on this horrible test for a common thing with babies and not use the basic diagnostic tools with others. The only thing I can imagine is that there is little money to be made or there is an astounding level of ignorance.



Frank

[hummingbear]

any other information....... like how did the doctor catch a urine sample, did they culture for the pathogen prior to prescribing antibiotics, how is DS doing, how do they plan on doing a follow up urine sample, did they retract to catch the sample etcccccccccccccccccc

[keptwoman]

I dont know that I would be willing to wait until 3 tests, even one infection can damage the kidneys if they have reflux. My daughter has it, diagnosed by VCUG after 1 infection, I had it undiagnosed until I was 4 and I sustained kidney damage which will likely affect me in later life.
Yes the VCUG is awful, but it is very quick and they may be able to do it under anaethesia of some sort. Don't dismiss it out of hand.
I guess if you are doing weekly urine testing (although that can be a nightmare!) and will detect another infection very quickly it wouldnt hurt to hold off, but if he got one more I would be getting a VCUG quick.

[mamaverdi]

Prevailing medical opinion is 1 UTI in a boy, 2 UTIs in a girl, necessitates Ultrasound and VCUG. UTI means cultured urine is positive for bacteria growth. A bladder infection is different from UTI---bladder infection is cystitis and does not include blood in urine or fever. Despite whoever this nephrologist is in Boston---this isn't the prevailing thought on UTIs. Cystitis, maybe.

The VCUG is extremely uncomfortable. The catheter insertion is not the worst part. Filling up the bladder with the foley blocked is probably worse. Or peeing through a slightly abraded urethra---after catherization.

But kidney damage or loss can mean dialysis or transplant. These things are not cures; they are treatments. Not only do they have a high-level of failure, but they are very painful to endure. And you have a lot more than 1 VCUG when you are in kidney failure.

Having a VCUG at a children's hospital with someone to help distract the child (they have child-life specialists who help with this), or they can even eat M&Ms or something while they do the test....helps a lot. And as long as the child's mommy isn't pregnant, she can accompany the child through the entire test.

mv

[MCatLvrMom2A&X]

I didnt mean to say that the VCUG should not be done at all but I think truly in my dd's case that after 1 UTI to put her thru that test was jumping the gun a bit. Also the test wasnt fast at all it took about 5 min that felt like 5 years and it took 4 people plus myself to hold her down with me doing all I could to talk to her and trying not to at that point in time she was still very much afraid of any stranger and was hysterical. Screaming my name over and over and me not able to help her On the ride home she was so quiet and withdrawn

I guess in the long run it is good to know that she didnt have the reflux but ugggh what a awfull memory

When I had my cath done when I was pg with ds very early on cause of abdominal pain the insertion of the cathiter was just as bad if not worse than the "gallon" of water they put in me for the u/s.

If there is a family history of it then my thinking would be yes after 1 UTI have the VCUG. As for doing some form of anesthesia I would be totally not comfortable with druging a young baby/toddler without a true medical emergancy just not worth the risk.

I know that my own experiance has really colored my opinion but honestly UTI is 1 of the most common things in young children I do think it is good to be safe than sorry but when it comes to inflicting that kind of terror on a baby like that then I think caution would be best at least for me and my kids. It isnt something to be taken lightly.

[keptwoman]

There is some kind of drug they give here which doesnt make the pain any less awful at the time but makes the child forget it happened. Now I know that that sounds pretty extreme, but I still remember my VCUG as a 5 year old as extremely traumatic. I couldnt stay with my DD, my DH did and I sat outside and cried the entire time, but she was a baby and will have forgotten it by now. She will have to have a repeat at some stage and I will be demanding the "forgetting" drug so she doesnt end up with a long term horrid memory.

[shaylahc]

Originally Posted by mamaverdi

Prevailing medical opinion is 1 UTI in a boy, 2 UTIs in a girl, necessitates Ultrasound and VCUG. UTI means cultured urine is positive for bacteria growth. A bladder infection is different from UTI---bladder infection is cystitis and does not include blood in urine or fever. Despite whoever this nephrologist is in Boston---this isn't the prevailing thought on UTIs. Cystitis, maybe.

The VCUG is extremely uncomfortable. The catheter insertion is not the worst part. Filling up the bladder with the foley blocked is probably worse. Or peeing through a slightly abraded urethra---after catherization.

But kidney damage or loss can mean dialysis or transplant. These things are not cures; they are treatments. Not only do they have a high-level of failure, but they are very painful to endure. And you have a lot more than 1 VCUG when you are in kidney failure.

Having a VCUG at a children's hospital with someone to help distract the child (they have child-life specialists who help with this), or they can even eat M&Ms or something while they do the test....helps a lot. And as long as the child's mommy isn't pregnant, she can accompany the child through the entire test.

mv

I agree 100%!!!! My 2nd child had kidney reflux (and was only born with 1 kidney, something we may not have learned if she had never had the kidney ultrasound and VCUG! : ). When she got her first UTI at 5 months, I assumed it was "just a fluke" too. It wasn't until she got the 2nd one several months later we realized there was a problem. With UTIs, it does NOT pay to wait. Permanent kidney damage can happen after just 1 kidney infection, damage that can mean high blood pressure or even kidney failure later on in life. Yes, a VCUG is a horrible test and no one wants to see their child suffer...but it is MUCH better to endure a VCUG than to be left wondering if your child has an underlying structural defect that will cause them major health problems if left untreated.

You can request sedation for a VCUG if you need to.

When my son developed a UTI and fever at 5 weeks, he was admitted to the hospital and had testing done which included a VCUG. Even though he turned out not to have the disorder, I was VERY happy to at least KNOW that kidney reflux was ruled out.

When my 2nd child had her first UTI, the ped said that when infants have UTIs, there is a 30-50% chance they have kidney reflux. I never thought in a million years I could have one of "those" kids, but I did We have NO family history of the disorder, either.