5 year old boy with recurrent UTI's

[Mummato2]

Has anyone else had this experience?

I have an almost 6 year old with absolutely no history of UTI until 4 months ago when he got his first undoubted UTI - pain, urgency, low grade fever. Dr said not worried but culture the sample and a second UTI warrants further testing.

3 months go by and DS tells me it hurts to pass urine (no urgency, no pain in bladder just at the end of weeing). Took him to the same Dr, urine stick test shows blood, diagnoses UTI and starts AB and orders ultrasound.

We go home and I discover the tip of his penis is red and swollen (not circumcised) and it makes sense it isn't a UTI but we complete antibiotics. Didn't follow up with ultrasound.

Then yesterday (3.5 weeks after last incident) DS throws up during the night once, wakes up with no other symptoms except urgency and increased frequency to pee. Take him to a different Dr who says he definitely needs imaging done, starts him on a different antibiotic, suggests a pediatric urologist and circumcision.

DS wakes this morning not so urgent with peeing (but a slight increase from normal)

What would you do? I really need some mumma's to bounce off.

1) I don't believe circumcision is warranted. Especially because he doesn't have a history of UTI until recently

2) Dr said likely won't be a structural issue since those generally appear from baby BUT that VUR (reflux) needs to be excluded because of potential kidney damage if it is.

Does this sound like 3 true UTI's?

One remark made last night is the treatment so far has been poor. We cultured the sample both times (this one has been sent off as well) but neither time did the Dr contact me to advise what we are dealing with or to change to a bacteria specific antibiotic.

I am at a loss as to how many invasive exams and procedures I want to allow. I refuse the circumcision. The ultrasound is non invasive so I don't mind that BUT it won't show VUR. The test for VUR is invasive and I worry about mt DS' s emotional tolerance since he is so acutely aware of his penis and gets quite shy. Kids apparently grow out of VUR as it is.

I need some guidance please. What would you do if this were your baby?

Thanks for getting through this xxx

[Rivlas]

If this was my child I would ask for a referral to a children's specialist who deals with these problems.
For him to have so many in such a short time, he needs to be checked out by someone other than your local GP

As a mum, I always preferred things looked at properly than been given the run around.
I preferred to be told they were fine than the other way cause I didn't listen to my gut feeling.

[Mummato2]

Very true. I guess the fine line is to what extent do you test? I think this is what I am having the hardest time over. I agree - we have an appointment with the pediatric urologist next month but in the meantime we can get the ultrasound done (least invasive)

So stressful and anxiety causing! I hate seeing my little one go through this

[xXHopeXx]

Just a thought, I know when I get UTIs, (very prone but no problems structurally, I just have a urtethra on the narrow end of normal so more prone) I HAVE to have probiotics afterwards because if I dont I get recurring UTIs from the lack of good bacteria helping to stave off any bad bacteria. They are all genuine infections, but it wouldn't necessarily have happened if I hadve taken probiotics iykwim?
Could you try giving him some and seeing if that helps? He can even take them during the course of ABs, just take the probiotics at least a few hrs after the ABs.
I only suggest that because he's never had one before this so it seems strange to get so many all of a sudden at his age.

Only other thing I can think of is do you still help shower/bathe him? If not, maybe a possibility could be that he may not be cleaning himself properly?

[Mummato2]

Exactly what our local naturopath said. She told me it's common for kids to get UTI's after a course of AB's if no acidophilus is given. So I bought him some inner health plus immune boost for kids.

She explained that both the digestive and urinary tract are made of the same membranes and thus why pro biotics help stop overgrowth of bacteria (vs cranberry which just stops it adhering to the walls)

As for the showering, he still showers with his daddy so hygiene is pretty good.

It is strange that he has never had a UTI til last year and the second wasn't actually a UTI (we discovered the infected penis) I have to wonder if a combination of AB's, and no follow up has resulted in that infection never quite clearing and that's what we are seeing now.

[No.5]

My DS has never had a UTI but somehow the skin at the tip (not circumcised either) did split. Mentioned it to a friend and she said it had happened to her son a month or two earlier and that it was a common occurrence around that age. I'd never heard of it before but can't say I have a whole heap of friends with boys. I took my son to the GP and he wasn't really concerned at all and said it'd heal itself and to keep an eye on it that it didn't get infected.

Whatever it happening, hope it gets sorted soon. Can't be pleasant for your poor DS

[Rivlas]

Just another thought.....does he play in a sandpit or dirt heap.

These are both breeders for UTI's.
My solution for these areas was to make sure they wore long pants or leggings when playing in dirt or sand.

Get the Ultrasound done before your other appointment as it might be all you need and you may as well save yourself time by getting it done now.

[Mummato2]

We have the ultrasound booked for the 4/3 and the pediatric urologist on the 27/3. I have made an appointment with my dr tomorrow to get copies of the pathology for the three samples sent.

Interestingly I read that boys who suffer constipation who present with non febrile uti is likely to be caused by lifestyle (hard poo in bowels pressing on the bladder causing ineffective voiding). Apparently a normal renal ultrasound coupled with the constipation and no fever with the uti yields a high result of it being this vs VUR

Massive sigh of relief when I read this but still important to get the scan to see if it points to another issue.

I'll remember the dirt and long pants.

[nickle730]

Hey Mummato2, my DS (8) has renal problems. He was born with a congenitally absent kidney and the one he does have has many structural abnormalities and moderate VUR (an improvement on the severe reflux he had for the first few years!). I think suggesting circumcision at this stage is jumping the gun! My DS was circumcised at 12 months of age (under GA whilst a couple of other procedures were performed), we did so after multiple UTI's and pyelonephritis, despite prophylactic antibiotics from birth. I mainly wanted to let you know that US will give a very good indication of VUR. If the results of the US suggest reflux, then I would consider more invasive tests. We used to check my DS's kidney every 3 months with US and every 6 months with a MAG3, but the MAG3 was very unpleasant and really gave us little more information than the US. I refused the MAG3 from 18 months-ish (maybe 2 years??) of age unless there was an indication on US that there had been a dramatic change to my DS's renal function. What state are you in? If you are in Vic, I would very happily recommend my DS's urologist, he is fantastic.

[Mummato2]

Thanks for such an amazing reply nickle xx I'm sorry your baby boy has had such a rough ride with renal issues from birth!

I am in NSW but met with another GP in the practice today about our specific situation.

The last 3 infections have been due to the bacteria "proteus mirabilis" which is apparently predominant in male UTI's (after e coli). The only concerning thing is this particular bug can become complicated when left untreated and is usually the bug responsible for pyelonephritis.

That said, he did say that the first infection being at age 5.5 years is far less concerning than if it were from under 4 and he said ultrasound these days gave an excellent indication of the condition of the kidneys and bladder as well as an indication of whether VUR is present.

I'm happy with that. The dr was also really reassuring that he doesn't expect to see any real damage from these infections because we've treated them immediately with bacteria sensitive antibiotics, he has only had 2 true UTI's and the lack of high fevers etc (which apparently is a good indication the infection remained lower in the urinary tract)

He explained that even if we found VUR at this stage treatment would be low dose daily antibiotic and management for breakthrough UTI's. This is of course unless we see any damage - again not expected but we would be negligent if we didn't check.