PEDIATRICS
DIAGNOSIS
The diagnosis of UTI depends upon obtaining an appropriate sample. In children
under the age of two, the bladder should be catheterized.
■ + Nitrite
■ Moderate (or greater) leukocyte esterase
■ + Gram stain for bacteria
■ >10 WBC/hpf
■ If there is a clinical suspicion for UTI, a urine culture should be obtained.TREATMENT
■ Septic children or infants: Admit for IV antibiotics
■ Mild infection (cystitis): Consider oral antibiotics with close follow-up
■ Children <3 years old with the first UTI should receive radiographic eval-
uation for vesicoureteral reflux, and for structural abnormalities of the kid-
neys and ureters.
■ Renal ultrasound
■ Voiding cystourethrogram (VCUG)
■ Patients with reflux or pyelonephritis should have a nuclear medicine
study with dimercaptosuccinate (DMSA) to evaluate for renal scarring.
■ Children with reflux should receive prophylactic antibiotics, and have
close follow-up with a pediatric urologist. Surgery may be required to
correct VUR.COMPLICATIONS
■ Reflux is present in up to 50% of infants who have a UTI.
■ Children with reflux are at risk for renal damage, resulting in chronic
renal insufficiency, and an increased risk of hypertension.HydroceleA hydrocele is a collection of fluid around the testicle. There are three cate-
gories of hydroceles:- 1° hydrocele: Infants born with excess fluid in scrotum—typically resolves
spontaneously by 1 year of age; not significant - 2° hydrocele: Reactive fluid collection within scrotum due to infection,
trauma, testicular torsion, or tumor - Communicating hydrocele: Fluid collection due to the presence of an
indirect inguinal hernia, which allows fluid to communicate between the
peritoneum and scrotum
SYMPTOMS/EXAM
■ 1° hydrocele: Nontender fluid collection in scrotum, typically transilluminates
■ 2° hydrocele: Hydrocele may be an incidental finding in the setting of
infection, trauma, testicular torsion, or tumor.
■ Communicating hydrocele (indirect hernia): Typically nontender, with
size of hydrocele increasing during the course of the day, and resolving after
the child has been lying flat (gravity draws fluid back into peritoneum)DIFFERENTIAL
■ Incarcerated inguinal hernia
■ Testicular torsion