Pediatric Urologic Infections and Inflammatory Conditions
Core concepts
Know the diagnosis and management of febrile urinary tract infection in children, including the role of urine culture, empiric antibiotics, and imaging. Vesicoureteral reflux grading and the debate over antibiotic prophylaxis are high-yield. Understand the association of UTI with anatomic anomalies and the importance of bowel and bladder dysfunction. Recognize acute pyelonephritis, renal abscess, and xanthogranulomatous pyelonephritis. Inflammatory conditions: balanitis, posthitis, and the role of circumcision; epididymitis and orchitis; and the distinction from torsion. Understand the evaluation of recurrent UTI, including ultrasound and voiding cystourethrogram when indicated. Know the principles of antimicrobial stewardship and the duration of therapy.
Traps
- Treating asymptomatic bacteriuria in children.
- Ordering VCUG in every first febrile UTI; it is reserved for selected cases.
- Missing torsion when diagnosing epididymitis.
- Forgetting that bowel and bladder dysfunction predisposes to UTI.
Worked example
A 2-year-old with a first febrile UTI should have urinalysis and culture, empiric antibiotics, and a renal ultrasound; VCUG is considered if there are risk factors such as recurrent infection or abnormal ultrasound.
Rule of thumb
Culture-confirmed febrile UTI plus anatomic or functional risk factors drives imaging, not every infection.