Bladder exstrophy: We need to improve. A lot

Jesus, Lisieux Eyer de; Dekermacher, Samuel; Pippi-Salle, Joao L.

doi:10.1016/j.jpurol.2021.11.007

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…If reimplantation is not performed primarily, emphasis should be placed in identifying those with VUR and use of prophylactic antibiotics should be considered. Continence remains a challenging issue in this population, with a high rate of CIC dependence or augmentation cystoplasty, both of which are associated with UTI [ 107 ]. In addition, those found to have continence after repair tend to have higher rates of VUR and recurrent febrile UTI [ 81 , 108 ].…”

Section: Unique Populationsmentioning

confidence: 99%

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Contemporary Management of Urinary Tract Infections in Children

Olson

Dudley

Rowe

2022

Curr Treat Options Peds

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Purpose of Review Urinary tract infection (UTI) in children is a major source of office visits and healthcare expenditure. Research into the diagnosis, treatment, and prophylaxis of UTI has evolved over the past 10 years. The development of new imaging techniques and UTI screening tools has improved our diagnostic accuracy tremendously. Identifying who to treat is imperative as the increase in multi-drug-resistant organisms has emphasized the need for antibiotic stewardship. This review covers the contemporary management of children with UTI and the data-driven paradigm shifts that have been implemented into clinical practice. Recent Findings With recent data illustrating the self-limiting nature and low prevalence of clinically significant vesicoureteral reflux (VUR), investigational imaging in children has become increasingly less frequent. Contrast-enhanced voiding urosonogram (CEVUS) has emerged as a useful diagnostic tool, as it can provide accurate detection of VUR without the need of radiation. The urinary and intestinal microbiomes are being investigated as potential therapeutic drug targets, as children with recurrent UTIs have significant alterations in bacterial proliferation. Use of adjunctive corticosteroids in children with pyelonephritis may decrease the risk of renal scarring and progressive renal insufficiency. The development of a vaccine against an antigen present on Escherichia coli may change the way we treat children with recurrent UTIs. Summary The American Academy of Pediatrics defines a UTI as the presence of at least 50,000 CFU/mL of a single uropathogen obtained by bladder catheterization with a dipstick urinalysis positive for leukocyte esterase (LE) or WBC present on urine microscopy. UTIs are more common in females, with uncircumcised males having the highest risk in the first year of life. E. coli is the most frequently cultured organism in UTI diagnoses and multi-drug-resistant strains are becoming more common. Diagnosis should be confirmed with an uncontaminated urine specimen, obtained from mid-stream collection, bladder catheterization, or suprapubic aspiration. Patients meeting criteria for imaging should undergo a renal and bladder ultrasound, with further investigational imaging based on results of ultrasound or clinical history. Continuous antibiotic prophylaxis is controversial; however, evidence shows patients with high-grade VUR and bladder and bowel dysfunction retain the most benefit. Open surgical repair of reflux is the gold standard for patients who fail medical management with endoscopic approaches available for select populations.

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Section: Unique Populationsmentioning

confidence: 99%

“…In one study that evaluated intravesical gentamycin, serum levels were indetectable and development of antibiotic resistance low (4.16%) [ 109 ]. Since patients with BE report high rates of recurrent UTI and renal scarring in adulthood, this population requires close urologic care in childhood and beyond [ 107 ].…”

Section: Unique Populationsmentioning

confidence: 99%