Pediatric uroradiology update

Adequacy of urinary tract infection management among minority underserved children

Urinary tract infection (UTI) is one of the common bacterial infections in children and may lead to substantial morbidity. This study examines (1) the frequency of the performance of follow-up urine cultures and imaging studies for children diagnosed with UTI and (2) the relationship of the demographic and insurance status of patients with the management and follow-up of UTI. We conducted a retrospective chart review of children with first-time documented UTI at six different county medical center satellite outpatient clinics and hospital-based pediatric outpatient walk-in clinics, serving an indigent minority community, from January 1998 to December 2000. We identified 144 children with confirmed UTI. Of 144 subjects in our study, 44% had follow-up urine cultures and 43% of these children showed continued infection after a full course of antibiotics. Renal ultrasonography and voiding cystourethrogram were performed in 53% and 39% of children, respectively. Of those patients who did not receive follow-up imaging, 67% had no documentation for follow-up appointments. However, in 29% of cases attempts had been made to contact patients who were scheduled for follow-up, but they did not return for the studies. These data suggest there is a significant failure rate for the follow-up of pediatric UTI. There is need for educational intervention among pediatricians who provide medical care to ethnically diverse underserved, often uninsured, minority children. This intervention should reinforce compliance with the standard recommendations for appropriate UTI follow-up studies and imaging and provide realistic strategies for achieving recommended outcomes in these high-risk populations.

Diagnostic procedures for the urogenital system

In making clinical decisions concerning the urogenital system, the emergency department physician has many different diagnostic tools at his or her disposal. Choosing the appropriate diagnostic study can often be difficult. For well over a thousand years, the initial step in assessing almost any urologic condition has been to examine the urine. Thankfully, this has progressed from a gustatory approach to the modern urinalysis. There is certainly a great deal of information that may be gleaned from the urinalysis, but the physician must also be mindful of its limitations. Overuse of the urinalysis can result in unwanted and unhelpful information. Although IVP is still the study of choice in assessing the functional status of the kidney, the introduction of CT and ultrasound technology to clinical medicine has revolutionized the emergency department assessment of the urogenital tract. CT and ultrasound can help differentiate between the urologic emergencies and the various surgical conditions that can mimic them.