Urinary Tract Infection (UTI) and Vesicoureteral Reflux (VUR) in Children

Urinary Tract Infection (UTI) and Vesicoureteral Reflux (VUR) in Children

Accepted 133 134 URINARY TRACT INFECTION (UTI) AND VESICOURETERAL REFLUX (VUR) IN CHILDREN.*Jaakko Elo, Helsinki,SF. 91 boys and 234 girls visited t...

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URINARY TRACT INFECTION (UTI) AND VESICOURETERAL REFLUX (VUR) IN CHILDREN.*Jaakko Elo, Helsinki,SF. 91 boys and 234 girls visited the out-patient clinic of Aurora for UTI. Children with neurogenic bladder were excluded. Study consists of episodes from 1960 to 1985. The severity of episodes was registered into 3 groups:1 asymptomatic (ABU), cystitis(C) and pyelonephritis(P). The criteria for P were fever, elevated blood sedimentation (BSR), C-reactive protein (CRP), leucocytosis (L) and P-fimbriation of E.coli. Chad bladder symptoms, no fever, normal BSR,CRP,L and no P-fimbriae. Urography and cystography were done to all. These were repeated, several times for some. Lately ultrasonography and radionucleide imaging were used. The age distr. of episodes, the treatment and remission time were registered. The state of kidney scarring was registered from images. Scars appearing in first examinations(S), the progression of scarring(P) and formation of fresh scars (FS). 3 boys and 8 girls had antireflux operation. RESULTS: the girls were observed for 7.1yrs (boys 3.8yrs.). The onset of UTI was earlier among children with VUR than without. The small number of children with antireflux operation had more S,P, and FS than the nonoperated; hence they were classified together. Children with VUR III-IV had more scars than children without VUR(P<0.001). Among girls with VUR III-IV there were more P and FS than among girls without VUR. Therewas no significant P or FS among boys. VUR I-II behaved similarly to non-VUR. A coexisting obstructive factor was very determinant in formation of S. Early diagnosis and effective treatment prevent best renal scars. At risk are those with febrile episodes and obstructive uropathies. Antireflux operations are beneficial only in selected cases.

SEROLOGICAL STUDIES OF CHLAMYOIA TRACHOMATIS(CT) EPIOIOYMITIS *Hi royuk i Kojima, Tokyo, Japan; *San-pin Wang, *Cho-chou Kuo and*J. Thomas Grayston, Seattle, WA {Presentation to be made by Dr. Kojima) CT is at present recognized as the most frequent pathogene of sexually transmitted disease and has been revealed to be a Cdusative organism of epididymitis. Although acute epididymitis is easily dia9nosed clinically, the etiological diaanosis has not been satisfactory, because of the difficulties to obtain adequate specimens for microbiological studies from infected epididymis without contaminations. CT could be isolated from epididymal aspirate, but can not from semen, because semen is toxic to cell culture. The aim of this study is to evaluate clinical efficacy of serological diagnosis for CT epididymitis. 39 patients with acute epididymitis were subjected to microbiologic studies of urine and semen specimens ~,hich were collected in parallel and serially from onset of the clinical symptoms and in follow-up period after treatment. Serological studies were performed by micro irnmunofluorescent method. In 24 patients {62%) the disease was associated with CT infection. All 24 showed positive serological responce and six had elementary bodies demonstrated in direct smear by fluolescent antibody technique using antiCT species- spec if i c monoc 1ona l anti body. The patients with positive CT serology were 88% {21/24) of the patients 35 years of age or younger and

135 EPIDIDYMITIS IN INFANTS AND BOYS: UNDERLYING UROGENITAL ANOMALIES AND EFFICACY OF IMAGING MODALITIES.*Andrew Siegel, Philadelphia, PA. (Presentation to be made by Dr. Siegel. Between 1975-85, 47 patients at Children's Hospital of Philadelphia were diagnosed with epididymitis. Most presented with scrotal erythema, swelling and pain. 28% underwent scrotal exploration at which time the diagnosis of

epididymitis was made, 17% (8/47) had an underlying urogenital anomaly. 47% (8/17) pre-pubertal patients including 75% (3/4) infant patients had an underlying anomaly. Early presentation increases the likelihood of discovering an underlying anomaly, usually a pathological connection of the urinary tract to the genital ducts or bowel. The spectrum of underlying anomalies included: ureteral ectopia to the vas, ureteral ectopia to the seminal vesicle, vasal ectopia to the bladder, urethral duplication, a congenital

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bulbous urethral stricture, a large prostatic utricular cyst with both vasa entering the utricle, a rectourethral fistula, and a case of urethra-ejaculatory duct reflux. Although a positive urine culture was suggestive of an underlying anomaly (positive predictive value 0.60), a negative culture makes the presence of an anomaly very unlikely (negative predictive value 1.00), Of the 8 patients with underlying anomalies, 6 underwent voiding cystourethrography (VCUG) and in all cases this established the diagnosis. 6 underwent intravenous urography (IVU) and in 67%, the diagnosis was made. Thus, VCUG is the imaging modality with the greatest diagnostic yield. Any prepubertal patient with epididymitis merits a urine culture, a VCUG, and an IVU in an effort to search for an underlying urogenital anomaly, as these are often amenable to surgical cure. 7 of the 8 patients with underlying anomalies underwent successful surgical t·herapy which generally involved severance of the pathological urinarygenital or urinary-fecal connection.

20% (3/15) of the patients older than 35.

In most of the patients who

did not have evidence of acute CT infection, other bacteria were isolated as causative organism. Among 24 CT seropositive patients, serum IgM antibody was positive in 8 cases, and lgA secretry piece in semen was positive in 9 cases. The maximum titers of serum IgM, lgG, semen lgMAG and JgA secretry piece were 128, 256, 1024 and 256 respectively. CT serotype specificities serum and semen antibody of each patients were in agreement with eachother. Above results suggest that the majority of acute epididymitis in young males is caused by CT. The antibody titers in semen tended to be higher than those in the sera during the early stage of disease . From 25 parallely collected semens and sera during the first month of disease, a geometric mean titer of 1:73 was obtained for the semens and 1:21 for the sera. Demonstration of CT antibody in semen appears to provide a simple and sensitive dia.gnosis of acute CT epididymitis.

136 Cl\SE--CONI'ROL S'IUDY OF PROSTATIC I.DCALIZATION CUlfIURES IN MEN WI'lli CHRONIC PROSTATITIS.

Richard E. Berger, John N. Krieger, *C. A. Paulsen, *K. K. Holmes. Seattle, Washington. (Presentation to be made by Dr. Berger) Men with chronic "non-bacterial prostatitis" often undergo prostatic localization cultures to detennine the etiology and treatment of this comm::m corrlition. However, the meanirq of these studies remains uncertain. We present the first case-control study addressirq both bacteriology and prostatic inflammation in men with the symptoms of prostatitis (non-bacterial prostatitis and prostatodynia) but without bacteriuria. We prospectively studie:i 50 asyi,r,tarnatic men (24 infertile and 26 nonnal volunteers) with no histo:ry of genitourinary infection and 34 men referred for the symptoms of chronic non-bacterial prostatitis. Both groups were evaluated by 4-glass prostatic localization cultures for aerobic bacteria, C. tracharnatis and U. urealytict.nn; and hernocytometer counts of prostatic fluid leukocytes. The patients more often had >1000 leukocytes/mm3 in prostatic secretions than controls (11/27 vs. 0/44) (p<.001). Patients had sigrrificantly fewer coag-negative staphylococcus (2.7 x 102 vs. 5.1 x 102 ) and U.urealyticrnn (1.0 x 103 vs. 8.8 x 103) in prostatic secretions. U.urealyticrnn was found in 1 log higher concentraton in prostatic secretions than in first-void urine in 0/30 patients vs. 13/50 controls (p<.0014). No other differences were found between cases and controls. Specifically no patient or control grew c.tracharnatis and we found no difference in the facultative bacterial localization cultures of men with non-bacterial prostatitis and men with prostatodymia. We conclude that prostatic localization cultures are neither useful in determining the etiology of non-bacterial prostatitis or in differentiatirq prostatitis from prostatodynia. Our study did not identify a bacterial etiology of chronic non-bacterial prostatitis.

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