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4 year old with reddish painful penis. History of pneumonia and UTI. Ultrasound of kidney and bladder fine. Is it a recurrence of UTI?

Answered by
Dr.
Dr. Hema Yadav

Pediatrician, Infectious Diseases

Practicing since :2005

Answered : 1528 Questions

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Posted on Fri, 22 Jun 2012 in Urinary and Bladder Problems
Question: My son (4 yeras old) is Allergic to cold. Recent history (2 months back) of pneumonia. One month back the blood was seen in the urin of my son complaining of irritation and pain in the penis while urinating, along with 3+ level of WBC and protien level to 1+. Urin culture showed no bectiria, UT (ultrasound) of kidney, bladder and abdomen was normal, x-ray of chest was normal and also there were no any clinical symptoms. Child was admitted for treatment of UTI and was discharged after 5 days with prescription of oral antibiotics for 5 more days. Urin analysis was done after completion of treatment, result were rbc-nil, wbc-occassional, protien-nil.
One week back the treatment for cough & cold with wheezing sound was given with 3 day course of antibiotics followed by prescription of Vit-B complex syrup for 7 days. Urinalysis was RBC-occasional, wbc-2-3/hpf, albumin-traces, epith cell-2-4/hpf while taking Vit-B Complex syrup-5ml each day. Child specialist has advised to wait for result of urin culture.Urin culture report will come on 01.01.2012. Tip of the penis is redish, my son is complaining of pain on tip of penis. No other symptoms. please advise what are the causes/disease of above urinalysis.
doctor
Answered by Dr. Hema Yadav 2 hours later
Hello,
Thanks for posting your query.
The urine analysis of your child is suggestive of a urine culture.
The cause of recurrent UTIs especially in a male child are
1. Some structural anomaly of the urinary tract like posterior urethral valves, stricture or vesicoureretric reflux.
2. Inadequate hygiene
3. Dehydration or decreased immunity due to other systemic illness or anemia.
Since he has already undergone ultrasound which is normal, it decreases the likelihood of anomalies.
I would suggest that you consult your paediatrician who can evaluate your child and prescribe investigations like
•     Complete blood count
•     Erythrocyte sedimentation rate
•     S. Calcium
•     Vitamin assays to rule out any systemic illness or nutritional deficiency.
•     Micturating cystogram (MCU) or intravenous pyelogram IVP to visualize the urinary system
The decision for such study should be taken by the paediatrician only if he feels that other minor deficiency or systemic illnesses are ruled out and there is strong suspicion regarding Urinary tract anomalies.
As of now, it's best to get the UTI treated according to the culture report.
Hope I have answered your query.
Regards

Above answer was peer-reviewed by : Dr. Aparna Kohli
doctor
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Follow up: Dr. Hema Yadav 2 hours later
Thank You Doctor for your quick response.
My question is whether it is possible to have UTI as I already mentioned.
If the awaited result of urin culture comes out to be negetive, what may the cause of above condition.
Is there any correlation of redness and pain in tip of urethra of child with urin analysis obtained as mentioned above.

Regards XXXXXXX XXXXXXX
doctor
Answered by Dr. Hema Yadav 17 hours later
Hello,
Thanks for follow up.
Yes, all urine is very less
•     It is caused by a fastidious (difficult to grow) organism
•     It's a viral systemic illness
•     Technical error occurs.
If the urine culture comes negative, the cause still could be UTI or urethritis or viral infection. In any case, the treatment would be the same, since an antibiotic course is necessary to prevent as well as treat bacterial infection.
The redness and pain at tip of urethra can be caused by any of these conditions: UTI, urethritis or viral systemic illness and the urine report is not positive due to these conditions. The redness and pain are signs of the mentioned illnesses.
Hope I have answered your query
Regards

Above answer was peer-reviewed by : Dr. Aparna Kohli
doctor
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Follow up: Dr. Hema Yadav 7 hours later
Thank you doctor for your careful examination of the case.
The urine sample of my son was given in another pathology for culture & urin analysis on 28.12.2011 after already one urin analysis was done on 27.12.2011. The result of urin analysis done on 27.12.2011 has already been mentioned in my first query (i.e. RBC- occ, WBC-2-3/hpf, albumin-traces, epith cell-2-4/hpf).

The Latest Reports of urin investigations are as below:-
(a) The result of urin culture done on sample given on 28.12.2011 is " No pyogenic organisms growth in primary culture".

(b) The result of urin analysis of sample given on 28.12.2011 is as under:
Colour-Pale yellow, Reaction-Acidic, protien-NIL, Sugar-NIL, RBC-NIL, WBC-Occ. Epi. Cells-2-4 /hpf, Casts-NIL, Crystals-NIL, Bacteria-NIL.

NOTE- It is to be noted that the latest reports at (a) & (b) are from a pathology of hospital of my organisation I work for, and the earlier report was from an independent private patholgy. Also the time duration between urination and reaching of sample to patholgy was almost 2 hours for first urin analysis done on 27.12.2011.
However we shall consult our paediatrician on 02.01.2012 (on Monday). Meanwhile we would also like to get your opinion based on th latest urin investigation reports as mentioned above.

Regards XXXXXXX XXXXXXX
doctor
Answered by Dr. Hema Yadav 16 hours later
Hello and thanks again,

The latest urine analysis report is suggestive of normal urine or a treated UTI) . I would consider it normal if child is asymptomatic and not on any medicine. If child has completed antibiotic course again then it could be a treated or cured UTI .

If child still has urethral pain and redness then it could be other viral systemic illness or local mucosal injury or rarely fungal infection. In such case you can wait for a week for healing and resolution of symptoms. If these symptoms persist then it would be good to get the blood counts repeated with or without imaging to rule out anomalies.

I presume the symptoms have improved. Else, mostly it should resolve on its own.

Hope I have answered your query. Please accept my answer if there are no further queries.

Regards

Above answer was peer-reviewed by : Dr. Prasad
doctor
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