Bladder/bowel dysfunction in pre-school children following febrile urinary tract infection in infancy
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ORIGINAL ARTICLE
Bladder/bowel dysfunction in pre-school children following febrile urinary tract infection in infancy Sofia Sjöström 1 & Ulla Sillén 1 Kate Abrahamsson 1
&
Marc Bachelard 1 & Ewa Johansson 1 & Per Brandström 1 & Anna-Lena Hellström 1 &
Received: 2 May 2020 / Revised: 22 September 2020 / Accepted: 6 November 2020 # The Author(s) 2020
Abstract Background An association between bladder-bowel dysfunction (BBD) and urinary tract infection (UTI) is well-known. However, a question less explored is whether children with UTI early in life also have increased prevalence of BBD after they are toilet-trained. In this study, consecutively selected children with pyelonephritis during their first year of life were assessed for BBD at pre-school age. Methods Ninety-two children (51 boys) hospitalized due to pyelonephritis during their first year of life were assessed for BBD at median age 5.4 years. A validated BBD questionnaire, along with urine flow and residual volume measurements, was used for diagnosing BBD. During follow-up, the group was well-characterized regarding renal status, vesicoureteral reflux (VUR), and recurrent UTI. Results BBD was diagnosed in 35/92 (38%), of which the majority was sub-diagnosed with dysfunctional voiding (DV). There was a strong association between BBD and recurrent UTI during follow-up (p < 0.0001), but only a slight association with VUR status at presentation. Nevertheless, in the group with both BBD and VUR, recurrent UTI was four times higher (12/13, 92%) than in children who had neither VUR nor BBD (23%), (p = 0.0008). BBD was also associated with kidney damage (p = 0.017). Conclusion In children with pyelonephritis during the first year of life, 38% had BBD at pre-school age, regardless of whether they had VUR or not. The study shows an important association between BBD and recurrent UTI, so an assessment of BBD is therefore recommended for pre-school children with UTI, especially when they have history of pyelonephritis during infancy. Keywords Bladder/bowel dysfunction . Pyelonephritis during infancy . Urinary tract infection . Vesicoureteral reflux . Follow-up from infancy
Introduction Many studies have shown that bladder-bowel dysfunction (BBD) is a risk factor for UTI, especially in children with dilating VUR. In most of the existing studies, children with bladder dysfunction were investigated for UTI [1, 2], and inclusion in such studies was often restricted to certain highrisk sub-groups [3, 4]. Few studies have prospectively studied a group of young toilet-trained children with UTI and made an association with the presence of BBD. The exception is the * Ulla Sillén [email protected] 1
The Pediatric UroNephrology Center, The Queen Silvia Children’s Hospital, The Sahlgrenska Academy at the University of Gothenburg, 416 85 Gothenburg, Sweden
RIVUR/CUTIE studies [5, 6]. Both studies included patients with UTI, with and without VUR. Bladder/bowel function was investigated using a validated questionnaire (DVSS) for children who had been toilet-trained [7]. BBD w
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