The correct diagnosis of a UTI it is not simply based on a positive urine sample sent to the lab (urine colture)
There are infact well defined clinical criteria, beside sampling modalities, trying to differentiate a potentially harmful UTI of the upper urinary tract (pyelonephritis) frorm a lower urinary tract UTI (cystitis) or a positive urine sample without any clinical implication at all (asymptomatic bacteriuria).
Many times, perhaps too many, the initial incorrect “interpretation” of a presumed UTI generates an inevitable sequence of clinical-diagnostic decisions unnecessary for our young patient and highly stressful for the Family too.
This delicate balance in the decision process of a correct diagnostic approach is necessarily based on a complete and detailed past medical history which is often neglected or incompletely recollected.
A precise knowledge of the prenatal US history (if available), a detailed history of both voiding (micturating diary) and bowel habits represent fundamental elements to better understand any correlation between a UTI and a potential urological problem of anatomical (congenital) or functional (acquired) origin.
A clear example of this concept is represented by vesico-ureteric reflux (VUR) which involves nearly 1% of the general pediatric population but it can reach up to 30-50% if we consider exclusively the febrile UTI’s population.
VUR is a dynamic and intermittent phenomenon of urine backflow (reflux), of variable degree, from the bladder into the upper urinary tract.
There is a profound difference among the “primary” condition, genetically determined and often associated with a congenital renal damage (renal dysplasia) compared to the “secondary” condition related to a functional or neurogenic bladder behaviour which may lead to an acquired irreversible pyelonephritic renal damage (scarring).
The main therapeutic goal is necessarily only one and that is to protect the kidneys and to prevent the progression of a potential renal damage while, too often, the main attention is only focused to the “simple” endoscopic or surgical treatment of the reflux…
The Pediatric Urologist task must be to correctly identify the type of VUR and to choose the best therapeutic modality taking into account all multiple relevant variables (age, sex, degree,etc.)