4/15/2020 PedsUroFLO lecture highlights: Luis Braga on UTI’s

After watching Luis Braga’s lecture on UTI’s, I found the following points interesting or of clinical use to my practice:

  • Before 1 year of life, UTIs are more common in boys. After 1 year of age, UTIs are more common in girls.
  • To prevent one UTI, this is how many circumcisions need to be done in each patient population:
    • Normal boys: 111
    • Boys with recurrent UTIs: 11
    • Boys with high-grade VUR: 4
  • Dilating VUR (VUR grade 3,4 and 5) carries a higher risk of recurrent UTIs and scarring compared to non-dilating VUR.
  • Only 37% of patients with DMSA-proven pyelonephritis have VUR.
  • NICE guidelines recommend DMSA 6 months after atypical infections in children <3 years or recurrent UTIs in children older than 3 years.
  • Scarring is significantly increased by a delay in antibiotics.
  • Gaither et al 2020: This study concluded the following with regards to ultrasound after first UTI’s:

Screening RBUS after a first, febrile UTI in children age 2-24 months does not meet cost-effectiveness guidelines. Our findings support deferred screening until a second UTI

 

 

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