Causes of urinary tract infections
My baby is crying, has a fever, is not taking milk well, and is not coughing, wheezing, or having diarrhea. What’s wrong? A urinary tract infection must be expelled. On average, one in forty male babies under one year of age will have a urinary tract infection (2.7%), while surprisingly, fewer female babies in this age group have urinary tract infections (0.4%). It is also possible that there is more vesicoureteral reflux in males.
However, by school age, girls have three times more urinary tract infections than boys (0.03-1.2% for boys and 1-3% for girls). It is possible that this is related to the short urethra. Most bacteria from feces enter the urethra and bladder from the perineum. In children with vesicoureteral reflux, bacteria are more likely to enter the kidney and cause nephritis. Some Escherichia coli (E. coli), which attach to the urethral bladder epithelium by specific pili and fimbriae, are the most common bacteria causing urinary tract infections.
Some bacteria come from the space between the foreskin and the glans. In circumcised boys, the glans is exposed and drier, and the chance of urinary tract infections is reduced by 10-12 times. However, I personally do not believe that this means that every newborn should be circumcised; my practice is to selectively circumcise boys with congenital urinary tract anomalies.
After puberty, when a girl starts having sex or becomes pregnant, there is an increased chance of urinary tract infections.
Why are you so nervous about urinary tract infections? Because growing kidneys are more fragile than adults, and 17% of urinary tract infections cause permanent damage to the kidney, leaving a scar. And 10-20% of these children with scarred kidneys will have high blood pressure. This shows the seriousness of urinary tract infections.
Rule out congenital urinary tract abnormalities
Unlike in adults, it is important to rule out congenital urinary tract abnormalities in infants under six months of age because the first clinical sign of many abnormalities such as hydronephrosis and vesicoureteral reflux is a urinary tract infection. If a baby is infected before birth, the probability of congenital disease is much higher than in adults. UK NICE guidelines recommend ultrasound for all babies with urinary tract infections under six weeks.
For recurrent infections (second or more inflammations) or infections caused by uncommon bacteria, children should have a voiding cystourethrogram to rule out vesicoureteral reflux, posterior urethral valves or ureteral bulges, and malformations of the bladder space. An isotope renogram (DMSA) is also recommended to determine renal function and to explore the extent of renal scarring. Parents do not need to worry about isotopes, which are only one-fifth the radiation of a single X-ray.
After treating these babies under six months of age, UK GPs will see a pediatric urologist to rule out congenital malformations.
The flow of water does not corrupt the household. Urological malformations prevent the complete and fluid elimination of urine, giving bacteria the opportunity to multiply.
1. Incomplete urination.
a. Vesicoureteral reflux, there is always some urine reflux into the ureter or renal pelvis and urine cannot be completely excreted.
b. Repeated kidney, the upper kidney is usually very poorly functioning, together with hydronephrosis, i.e. the urine flows very slowly, just like a stinky ditch, and is easily inflamed.
c. Neurogenic bladder, where the urethral sphincter is not relaxed and the urine cannot be removed from the bladder, resulting in chronic urinary flow and reflux.
d. paraureteral bladder diverticulum (Hutch diverticulum), urination is not clean.
2. Urinary system obstruction.
a. renal pelvic ureteral interface stenosis, causing hydronephrosis
b. Vesicoureteral stenosis, causing giant ureter
c. posterior urethral valves, causing dyspareunia, neurogenic bladder, giant ureter, hydronephrosis, etc.
d. Ureteral bulges, whose cysts can cause ureteral obstruction, and in large ones, they may block the bladder neck and cause dyspareunia.
These congenital urinary anomalies, although not present in every child, should be thoroughly examined and should not wait until there is recurrent inflammation and permanent damage to the kidney or bladder before seeing a pediatric urologist.