pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Urinary Tract Infection

[A mother wonders about her nine-year-old girl with urinary tract infection symptoms.]

(The question has been lost but involved a girl with urinary tract infection symptoms)
Hygiene is always a concern in urinary tract infections. The most common cause in girls is wiping from back to front. “Holding it” also can precipitate a urinary tract infection due to concentrated urine and lack of proper “flow.” This could have been the case in a 9 year old who feels “inconvenienced” or “uneasy” with temporary toileting facilities.

A specific culture to find out which of many different bacteria possible is actually causing the UTI (urinary tract infection) does, in fact, take approximately 3 days unless the doctor performs the test in his office. HOWEVER, the diagnosis of a girl having a UTI can be immediate or within a few hours and temporary treatment begun without waiting for 3 days.

If this is a girls FIRST UTI then the above mentioned two reasons are so common that most pediatricians feel further diagnostic workup (beyond treatment to resolution) is not necessary. If a second infection occurs however, while the girl has been aware and avoiding the above mentioned causes, then further diagnostic workup is most often warranted with x-rays, or cystoscopy.

With UTIs in boys we take a different approach. Because the plumbing is different, wiping direction and pinworms don’t usually come into play so the very first UTI gets a thorough evaluation for anatomical issues.

Because subsequent UTIs are frequently “silent” (without symptoms) in a girl most pediatricians will place her on a “routine culture follow-up” per a routine that they develop.

This general medical information hopefully is of some benefit in ascertaining quality of medical care but obviously not designed to give specific treatment advice for any one patient.

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