5.4 References

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2. Anton Pacheco Sanchez J, Gomez Fraile A, Aransay Brantot A, Lopez Vazquez F, Encinas Goenechea A.

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3. Arun N, Kekre NS, Nath V, Gopalakrishnan G.

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5. Bomalaski MD, Hirschl RB, Bloom DA.

Vesicoureteral reflux and ureteropelvic junction obstruction: association, treatment options and outcome. J Urol 1997; 157: 969-974.

6. Borhan A, Kogan BA, Mandell J.

Upper ureteral reconstructive surgery. Urol Clin North Am 1999; 26: 175-181.

7. Chevalier RL, Klahr S.

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8. Dhillon HK.

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9. DiSandro MJ, Kogan BA.

Neonatal management. Role for early intervention. Urol Clin North Am 1998; 25: 187-197.

10. Ebel KD.

Uroradiology in the fetus and newborn: diagnosis and follow-up of congenital obstruction of the urinary tract. Pediatr Radiol 1998; 28: 630-635.

11. Jaby O, Lottmann H, Bonnin F, Weisgerber G, El Ghoneimi A, Aigrain Y.

Mega uretere primitif obstructif: reimplantation sur vessie psoique de premiere intention. Ann Urol Paris 1998; 32: 197-201.

12. Khan AM, Holman E, Pasztor I, Toth С

Endopyelotomy: experience with 320 cases. J Endourol 1997; 11: 243-246.

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Hydronephrosis. When is obstruction not obstruction? Urol Clin North Am 1995; 22: 31-42.

14. KoffSA.

Neonatal management of unilateral hydronephrosis. Role for delayed intervention. Urol Clin North Am 1998; 25: 181-186.

15. Liu HY, Dhillon HK, Yeung CK, Diamond D, Duffy PG, Ransley PG.

Clinical outcome and management of prenatally diagnosed primary megaureters. J Urol 1994; 152:614-617.

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Management of primary obstructive megaureter without reflux in neonates. Eur Urol 1993; 24: 505-510.

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Management and outcome of antenatally diagnosed hydronephrosis. Int J Urol 1994; 1:121-128.

18. Rascher W, Bonzel KE, Guth-Tougelidis B, Kropfl D, Meyer-Schwickerath M, Reiners C.

Angeborene Fehlbildungen des Harntrakts. Rationelle postpartale Diagnostik. Monatsschr Kinderheilkd 1992; 140: 78-83.

19. Reddy PP, Mandell J.

Prenatal diagnosis. Therapeutic implications. Urol Clin North Am 1998; 25: 171-180.

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Management of megaureter in children. Eur Urol 1998; 34: 73-78.

6. URINARY TRACT INFECTION (UTI)

6.1 CLASSIFICATION

Asymptomatic bacterium

Significant bacteriuria can be documented in consecutive urine samples without any symptoms.

Cystitis

The infection is limited to the bladder; irritative symptoms are present, but no systemic symptoms or fever.

Acute pyelonephritis

Febrile infection of the renal parenchyma.

Complicated UTI

Due to a urine transport disturbance, malformation or a relevant bladder voiding disturbance.

6.2 DIAGNOSIS

Indications for chemical and microbiological urine examination include fever of unknown origin, unclear growth impairment in infants, unclear abdominal complaints or flank pain, frequency, dysuria, smelly urine and gross haematuria. In infants and small children, urine is usually collected in a bag attached to the external genitalia. A positive urine culture requires confirmation by suprapubic puncture (withdrawal of urine by transurethral catheterization is optional). Once the child can void on demand, mid-stream urine is used in boys and transurethral catheterization in girls.

The urine examination consists of paper-strip tests, microscopy and microbiology. Only the examination of bladder puncture urine achieves a sensitivity of > 95%. In cases of a positive urine culture, complete blood count, differential blood count, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are determined together with clinical examination.

Sonography is performed to assess kidney volume, parenchymal echogenicity, thickness and scarring, anomalies (e.g. duplex system), hydronephrosis, dilatation of the ureter and calculi. Bladder wall thickness, bladder configuration, dilatation of the ureter (VCUG, to rule out reflux) and residual urine are assessed with a full bladder. In case of pyelocaliectasis, an IVU should be considered. A VCUG should be carried out after successful antibiotic therapy.

Table 7: Differential diagnosis of pyelonephritis

ESR = erythrocyte sedimentation rate; CRP = C-reactive protein