Abstract
Background
To compare clinical history and measurements of fecal load on abdominal radiography (AR) in the prediction of urinary tract infection (UTI) recurrence in children.
Methods
We combined data from two multicenter longitudinal studies in which children less than 6 years of age with a first or second UTI were followed for recurrence of UTI. Two radiologists reviewed the scout abdominal radiographs of initial voiding cystourethrograms obtained at enrollment from children at two participating sites and measured stool visible in various parts of the colon. We examined how well clinical variables (e.g., voiding and bowel history, use of laxatives at enrollment) and measurements of fecal load predicted recurrence of UTI within 12 months of enrollment.
Results
One hundred and ninety-two children were included. On univariate analyses, age, vesicoureteral reflux (VUR), cecal diameter, rectal diameter, and total stool length on AR were associated with recurrence of UTI. After controlling for age, the odds of recurrent UTI in children with VUR at baseline was 3.85 (95% CI: 1.62, 9.14) higher than in children without VUR. Recurrent UTI was 2.57 (95% CI: 1.01, 6.55) times more likely in children with cecal diameter > 3.10 cm than children with lower cecal diameters; time to first recurrent UTI was shorter in children with elevated cecal diameters (p = 0.0023).
Conclusions
Cecal diameter on abdominal radiographs predicts UTI recurrence in children with a previous UTI. However, its accuracy is suboptimal to serve as a screening test. Accordingly, its routine use for this indication is not supported. If cecal diameter on an AR ordered for another indication is > 3.10 cm, then management of constipation could be considered.
Similar content being viewed by others
Abbreviations
- UTI:
-
Urinary tract infection
- VUR:
-
Vesicoureteral reflux
- RIVUR:
-
Randomized Intervention for Children with Vesicoureteral Reflux
- CUTIE:
-
Careful Urinary Tract Infection Evaluation study
- BBD:
-
Bladder and bowel dysfunction
- AR:
-
Abdominal radiograph
- VCUG:
-
Voiding cystourethrogram
- DMSA:
-
Dimercaptosuccinic acid renal scan
- PACCT:
-
Paris Consensus on Childhood Constipation Terminology
- OR:
-
Odds ratio
- ROC:
-
Receiver operation characteristic curve
- AUC:
-
Area under the ROC curve
- KM:
-
Kaplan-Meier curve
References
Mingin GC, Hinds A, Nguyen HT, Baskin LS (2004) Children with a febrile urinary tract infection and a negative radiologic workup: factors predictive of recurrence. Urology 63:562–565 discussion 565
Koff SA, Wagner TT, Jayanthi VR (1998) The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol 160:1019–1022
Loening-Baucke V (1997) Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics 100:228–232
Blethyn AJ, Jenkins HR, Roberts R, Verrier Jones K (1995) Radiological evidence of constipation in urinary tract infection. Arch Dis Child 73:534–535
Marks A, Vasquez E, Moylan S, Diaz-Saldano D, Schreiber J, Saker M, Lindgren BW (2013) Definition of reliable, objective criteria by abdominal radiography to identify occult constipation in children with lower urinary tract symptoms. J Urol 189:1519–1523
Hoberman A, Chesney RW; RIVUR Trial Investigators (2014) Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med 371:1072–1073
Keren R, Shaikh N, Pohl H, Gravens-Mueller L, Ivanova A, Zaoutis L, Patel M, deBerardinis R, Parker A, Bhatnagar S, Haralam MA, Pope M, Kearney D, Sprague B, Barrera R, Viteri B, Egigueron M, Shah N, Hoberman A (2015) Risk factors for recurrent urinary tract infection and renal scarring. Pediatrics 136:e13–e21
Lee J, Koh D, Ong CN (1989) Statistical evaluation of agreement between two methods for measuring a quantitative variable. Comput Biol Med 19:61–70
Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428
Benninga M, Candy DC, Catto-Smith AG, Clayden G, Loening-Baucke V, Di Lorenzo C, Nurko S, Staiano A (2005) The Paris Consensus on Childhood Constipation Terminology (PACCT) Group. J Pediatr Gastroenterol Nutr 40:273–275
Nurko S, Zimmerman LA (2014) Evaluation and treatment of constipation in children and adolescents. Am Fam Physician 90:82–90
Moylan S, Armstrong J, Diaz-Saldano D, Saker M, Yerkes EB, Lindgren BW (2010) Are abdominal x-rays a reliable way to assess for constipation? J Urol 184:1692–1698
Pensabene L, Buonomo C, Fishman L, Chitkara D, Nurko S (2010) Lack of utility of abdominal x-rays in the evaluation of children with constipation: comparison of different scoring methods. J Pediatr Gastroenterol Nutr 51:155–159
Bijos A, Czerwionka-Szaflarska M, Mazur A, Romanczuk W (2007) The usefulness of ultrasound examination of the bowel as a method of assessment of functional chronic constipation in children. Pediatr Radiol 37:1247–1252
Acknowledgments
We would like to acknowledge Ilina Rosoklija, MPH, and Bruce Lindgren, MD, from Lurie Children’s Hospital of Chicago Division of Pediatric Urology for their contribution and initial vision during the development of this manuscript.
Funding
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases or the National Institutes of Health. This research was supported by grants U01 DK074059, U01 DK074053, U01 DK074082, U01 DK074064, U01 DK074062, and U01 DK074063 from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services.
Author information
Authors and Affiliations
Contributions
Drs. Muniz and Shaikh conceptualized the study concept and design, participated in the acquisition of data, drafted the initial manuscript, and approved the final manuscript as submitted. Drs. Kar and Gumus participated in the study design, acquisition, and interpretation of data; drafted the initial manuscript; and approved the final manuscript as submitted. Ms. Liu participated in the analysis of data, drafted the initial manuscript, and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
What’s known on this subject
Many articles have described a potential association between constipation and development of UTIs. We examined the presence and severity of fecal loading on abdominal radiographs of children diagnosed with UTIs as a potential predictor for recurrent infections.
What this study adds
We found that an increased cecal diameter on abdominal radiography was associated with UTI recurrence. These findings have important implications for the screening and treatment of constipation.
Supplementary Information
ESM 1
(DOCX 14 kb).
Rights and permissions
About this article
Cite this article
Muniz, G., Kar, E., Gumus, S. et al. Constipation on abdominal radiograph as potential risk factor for recurrent urinary tract infection development. Pediatr Nephrol 36, 2769–2775 (2021). https://doi.org/10.1007/s00467-021-04973-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-021-04973-5