Forthcoming Issue Vol 19 No. 3 The role of ultrasound in investigating paediatric urinary tract infections for urinary structural defects at Chris Hani Baragwanath Academic Hospital
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Abstract
Background: The amount of paediatric genitourinary ultrasounds performed with an indication of urinary tract infection (UTI) is abundant. However, there is minimal data regarding whether UTI is an appropriate indication for determining if urinary structural defects will be identified.
Objectives: The study aims to quantify structural urinary tract defects identified in the paediatric population presenting with UTIs. Further to this, diagnoses will be assessed according to gender and age group.
Methods: A retrospective review of 180 cases of paediatric ultrasounds done with an indication of UTI was performed. The data was collected from Chris Hani Baragwanath Academic Hospital (CHBAH) from March 2022 till November 2022. The urinary structural defects as well as the normal ultrasounds were identified and quantified.
Results: 12 different structural urinary tract defects were found in this study. The most common being hydroureteronephrosis. Duplex collecting system and pelviureteric junction (PUJ) obstruction were the second most common. Urinary structural defects were identified more in males than females, but the incidence was equal in all age groups.
Conclusion: There was no statistical significance between a diagnosis of UTI in children and the presence of a urinary structural defect. Further to this, once a urinary structural tract defect was identified, there was no statistical significance in diagnoses based on age or gender. A collaborative agreement between radiologists and paediatricians should be established to create improved criteria for identifying children at risk of urinary structural defects in each institution.
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References
1. Osuch E, Marais A. Urinary tract infections in children. South African Family Practice. 2018;60(1):35–40. doi:10.4102/safp.v60i1.4782
2. Lentz B, Fong T, Rhyne R, Risko N. A systematic review of the cost-effectiveness of ultrasound in emergency care settings. The Ultrasound Journal. 2021;13(1). doi:10.1186/s13089-021-00216-8
3. Marks SD, Gordon I, Tullus K. Imaging in childhood urinary tract infections: Time to reduce investigations. Pediatric Nephrology. 2008;23(1):9–17. doi:10.1007/s00467-007-0552-9
4. Pellegrino C, Capitanucci ML, Forlini V, Zaccara A, Lena F, Sollini ML, et al. Posterior urethral valves: Role of prenatal diagnosis and long-term management of bladder function; a single center point of view and review of literature. Frontiers in Pediatrics. 2023;10. doi:10.3389/fped.2022.1057092
5. Al Aara MS, Badreldin AM. Ureteropelvic junction obstruction - statpearls - NCBI bookshelf [Internet]. StatPearls Publishing; [cited 2023 Jun 14]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560740/
6. Swerkersson S, Jodal U, Sixt R, Stokland E, Hansson S. Relationship among vesicoureteral reflux, urinary tract infection and renal damage in children. Journal of Urology. 2007;178(2):647–51. doi:10.1016/j.juro.2007.04.004
7. Keuler N, Johnson Y, Coetzee R. Treating urinary tract infections in public sector primary healthcare facilities in Cape Town, South Africa: A pharmaceutical perspective. South African Medical Journal. 2022;487–93. doi:10.7196/samj.2022.v112i7.16258
8. Kilborn, Tracy, Halvani Moodley, Anita Brink, & Peter Nourse. A case-based approach to UTI imaging – making sense of the guidelines. South African Journal of Radiology, 19.2 (2015). https://doi.org/10.4102/sajr.v19i2.877
9. Andronikou, S., Welman, C., Kader, E., & McCulloch, M. Imaging strategy for South African children with their first proven UTI in a tertiary hospital setting. South African Journal of Radiology. 2001, 5(1), 4-8. https://doi.org/10.4102/sajr.v5i1.1484
10. Rasouly HM, Lu W. Lower urinary tract development and disease. Wiley Interdiscip Rev Syst Biol Med. 2013;5(3):307-342. doi:10.1002/wsbm.1212
11. Visuri S, Jahnukainen T, Taskinen S. Prenatal complicated duplex collecting system and ureterocele-Important risk factors for urinary tract infection. J Pediatr Surg. 2018;53(4):813-817. doi:10.1016/j.jpedsurg.2017.05.007
12. Didier RA, Chow JS, Kwatra NS, Retik AB, Lebowitz RL. The duplicated collecting system of the urinary tract: embryology, imaging appearances and clinical considerations. Pediatr Radiol. 2017 Oct;47(11):1526-1538. doi: 10.1007/s00247-017-3904-z. Epub 2017 Sep 21. PMID: 29043421.
13. Krajewski W, Wojciechowska J, Dembowski J, Zdrojowy R, Szydełko T. Hydronephrosis in the course of ureteropelvic junction obstruction: An underestimated problem? Current opinions on the pathogenesis, diagnosis and treatment. Adv Clin Exp Med. 2017;26(5):857-864. doi:10.17219/acem/59509
14. Al Aaraj MS, Badreldin AM. Ureteropelvic Junction Obstruction [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560740/
15. Blews DE. Sonography of the neonatal genitourinary tract. Radiol Clin North Am. 1999;37(6):1199-vii. doi:10.1016/s0033-8389(05)70257-8
16. Cleper R, Krause I, Eisenstein B, Davidovits M. Prevalence of vesicoureteral reflux in neonatal urinary tract infection. Clin Pediatr (Phila). 2004;43(7):619-625. doi:10.1177/000992280404300706
17. Berrocal T, López-Pereira P, Arjonilla A, Gutiérrez J. Anomalies of the distal ureter, bladder, and urethra in children: embryologic, radiologic, and pathologic features. Radiographics. 2002;22(5):1139-1164. doi:10.1148/radiographics.22.5.g02se101139
18. Kessler RM, Altman DH. Real-time sonographic detection of vesicoureteral reflux in children. AJR Am J Roentgenol. 1982;138(6):1033-1036. doi:10.2214/ajr.138.6.1033
19. Paladini D, Paolo Volpe. Ultrasound of congenital fetal anomalies : differential diagnosis and prognostic indicators. Boca Raton: Taylor & Francis; 2014.
20. Cordeiro LPV, Carvalho ACM, Silva IM, Martins FP, Amaro AP, Carvalho EM. Cystic partially differentiated nephroblastoma: a rare pediatric renal tumor-case report. Radiol Case Rep. 2020;15(8):1133-1137. Published 2020 Jun 5. doi:10.1016/j.radcr.2020.05.001
21. Johnin K, Kobayashi K, Tsuru T, Yoshida T, Kageyama S, Kawauchi A. Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children. International Journal of Urology. 2018 Dec 19;26(2):160–71.
22. Perisinakis K, Raissaki M, Damilakis J, Stratakis J, Neratzoulakis J, Gourt-soyiannis N. Fluoroscopy-controlled voiding cystourethrography in infants and children: are the radiation risks trivial? Eur. Radiol. 2006; 16: 846–51.
23. Ditchfield MR, Nadel HR. The DMSA scan in paediatric urinary tract infection. Australas Radiol. 1998 Nov;42(4):318-20. doi: 10.1111/j.1440-1673.1998.tb00530.x. PMID: 9833368.
24. Traisman ES, Conway JJ, Traisman HS et a/. The localisation of urinary tract infection with 99mTc glucoheptanate scintigraphy. Pediatr. Radiol. 1986; 16: 403-6.