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