tailieunhanh - Essential Urology - part 3

Sau khi điều trị ban đầu, trẻ em nên được đánh giá về nguyên nhân giải phẫu và chức năng có thể predispose nhiễm trùng đường tiểu hơn nữa. Điều này là quan trọng vì nhiều lý do. Trẻ em có bất thường sinh dục sẽ có một sự gia tăng tái phát nhiễm trùng đường tiết niệu và tăng nguy cơ thiệt hại thận | 38 Grady therapy single dose to 2 d also has been shown to be effective 17 . For single-dose therapy slowly excreted drugs like trimethoprim sulfamethoxazole are ideal 11 . EVALUATION After initial treatment children should be evaluated for anatomic and functional causes that may predispose them to further UTIs. This is important for several reasons. Children with genitourinary abnormalities will have an increased incidence of recurrent UTI and an increased risk for renal damage. Up to 50 of children who have had a febrile UTI will demonstrate an anatomic abnormality. Children should also be evaluated for functional conditions that may predispose to UTI as well. Up to 70-80 of older children have a functional condition such as detrusor instability that contributes to increased risk for recurrent UTI. Current recommendations from the AAP include the evaluation of all children after febrile UTI with a renal and bladder ultrasound examination and a voiding cystourethrography VCUG . Ultrasound examination yields approx 2-8 abnormalities including hydronephrosis ureterocele and posterior urethral valves. These abnormalities may be further characterized by other imaging studies such as Lasix renography or VCUG. Up to 50 of girls who have had a febrile UTI will demonstrate VUR on a VCUG study. Imaging Studies Some variation exists for the indications for imaging studies. The AAP guidelines recommend ultrasonography and VCUG for all children after the first febrile UTI 2 . Many experts also suggest these studies for any boy who has UTI whether associated with fever or not. Imaging studies for girls with afebrile UTI are typically not indicated. In contrast the UTI Working Group of the Health Care Office of the European Association of Urology suggests that imaging studies be deferred until the second UTI in girls and performed after the first UTI in boys 3 . Ultrasound imaging studies may be performed when convenient after initial treatment. Children should be maintained on