Relationship of Urinary Tract Infection to Lower Urinary Tract Dysfunction and Kidney Scar Formation in Children

Abstract

Background: Urinary tract infection (UTI) is the most common infection during childhood. Lower urinary tract dysfunction (LUTD) is a broad term that indicates an abnormal voiding pattern in a
child without anatomical and neurological impairment. The purpose of this study was to determine
the relationship between UTI and LUTD.

Methods: This study was conducted at the Children
Medical Center Hospital in 2014–2016. The inclusion criteria of this study were at least one
UTI confirmed by a positive urine culture and active urine analysis in children who were well
toilet‑trained previously. Complete physical examination of the genitourinary and skeletal systems
was performed to identify patients with anomalies in these systems. The patients with genitourinary
system anomalies and obvious and prediagnosed neurological defects of the urinary system such as
neurogenic bladder were excluded from the study. To confirm the presence of LUTD, the scoring
system of Akbal et al. was applied.

Results: A total of 260 patients including 9.2% of males and
90.8% of females were included in this study. The prevalence of LUTD was 63.8% (166 cases) in
these patients. In this study, the prevalence of LUTD in patients with a single episode of UTI was
50.5%, while in patients with recurrence of UTI it was 88.9%. In patients with unilateral kidney scar
formation, 90.9% had a recurrence of UTI (P = 0.003) which shows a strong correlation of unilateral
scar formation with recurrence of UTI.

Conclusions: These data suggest that there is a significant
relationship between UTI and LUTD in children, so evaluation of voiding dysfunction is necessary
in this group. With early diagnosis and appropriate treatment, we can reduce the possible serious and
permanent sequels of LUTD in patients with UTIs.

Keywords: Children, lower urinary tract dysfunction, scar formation, urinary tract infection