The significance of bacilluria in children on long-term intermittent catheterization.

We reviewed the records of 255 children who have been managed by clean intermittent catheterization during the last 10 years to determine the incidence of bacilluria and upper tract changes. Bacteriuria was documented in 56 per cent of the children but febrile urinary tract infections occurred in only 11 per cent and fresh renal damage in 2.6 per cent. In the absence of vesicoureteral reflux bacilluria proved to be innocuous, since vesicoureteral reflux, progressive hydronephrosis or increasing parenchymal scarring did not develop. Bacteriuria in association with low grade reflux was rarely harmful and the reflux actually disappeared in up to 50 per cent of cases. However, bacteriuria in patients with high grade reflux was not an innocent phenomenon, since not only did the reflux tend to persist but pyelonephritis occurred in more than 60 per cent of the patients. In this latter group of patients reimplantation is an important therapeutic consideration if sterile urine cannot be achieved.