Incidence of urological anomalies in children with urinary tract infections in India.

A total of 2,970 infants and children with symptoms suggestive of urinary tract infection (UTI) were investigated. Diagnosis was based on clinical, microbiological, radiological, and sometimes endoscopic investigations. Quantitative culture of an uncontaminated sample of urine is the most sensitive screening test. An additional 548 children had positive physical findings such as enlarged kidneys and/or bladder and were excluded from this study. There were 2,970 children with urinary symptoms but no definite positive physical findings, and this group is discussed in detail; 73% (2,168) were boys and 27% (802) were girls. The commonest presenting symptoms were frequency of micturition, enuresis, and straining on voiding. One hundred sixty-six had significant bacteriuria and were fully investigated. Only 148 children completed the investigations and treatment; 130 had an underlying structural abnormality causing stasis of urine. It is well known that removal of the cause of the stasis will help to prevent further infections in most patients, and also reduces the effects of back-pressure on the upper tracts. This study illustrates: (1) the importance of proper urine culture technique; (2) the high incidence (88%) of structural abnormalities causing UTI in children; and (3) the importance of investigating all children with proven UTI to determine the cause of stasis. In India, the patterns of UTIs and their causes are markedly different from those published in the English literature.