INVESTIGATION AND FOLLOW-UP OF 282 GIRLS WITH RECURRENT URINARY TRACT INFECTION (UTI)

Abstract

During 12 years, 282 girls were referred at age 3.4±3.8 (SD)yr, following 2 or more UTI. Of 266 investigated, 100 (38%) had vesicoureteric reflux (VUR), bilateral in 45. Radiologic pyelonephritis (PN) was found in 29% c. and 2.4% s. VUR. Other findings were: UP junction stenosis - 8, bladder diverticulum -17, meatal stenosis - 2, double ureter (DU) - 22 (8%). Mean referral time was 0.5 yr after first recognised UTI and unrelated to VUR or PN. Average follow-up was 4.1±3.1 yr; 55% and 45% respectively were followed 5 and 10 yr or until “cure” (2 yr s. UTI, normal radiology). Symptoms were systemic in 15% (more common c. VUR - p=0.01), local in 15%, absent in 70% of all UTI. Frequency of UTI diminished by 15% yearly; annual “cure” rate (2 yr s. UTI) was 9.5% in first 5 yr, 6.5% therafter and unrelated to VUR. Nitrofurantoin (61 patients), thrimethoprim/sulfa (59) and nalidixic acid (52) were equally effective, reducing UTI by 75%. VUR resolved spontaneously in 61% (rarely in grade III, IV or DU) and following surgery in 20%. Radiologic PN remained unchanged in 13, deteriorated in 12; 13 developed new PN - 9 c. and 4 s. VUR. GFR, BP, height and weight percentiles showed no significant differences c. or s. PN or VUR - no hypertension and only one abnormal GFR were seen.

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