Introduction

Learning objectives

Recognize the clinical presentation of urinary tract infection according to the child's age.
Understand the importance of a properly obtained urine sample.
Know that not every child with a urinary tract infection needs imaging studies.

Video lesson

▶

Video pending upload (embedded YouTube)

Summary

Why are they important?

A pediatric urinary tract infection may be the first manifestation of an anatomical or functional abnormality of the urinary tract.

This is particularly important in infants and young children.

Clinical presentation

It depends greatly on age.

Infants

They may present with nonspecific symptoms:

fever;
irritability;
feeding refusal;
vomiting;
lethargy.

Older children

They may present with:

dysuria;
urinary frequency;
urgency;
abdominal pain;
fever;
flank pain.

How is it diagnosed?

Diagnosis must be based on a properly obtained urine sample.

The collection method is especially important in young children because a contaminated sample can lead to an incorrect diagnosis.

Urinalysis provides guidance, and urine culture confirms the infection and identifies the microorganism.

When to suspect pyelonephritis?

Especially in the presence of:

fever;
systemic involvement;
flank pain;
vomiting;
elevated inflammatory markers depending on the context.

Does everyone need imaging studies?

Not necessarily.

The need for ultrasound or other studies depends on:

age;
characteristics of the infection;
course;
recurrences;
microorganism;
clinical findings.

Key concept

In Pediatrics, fever without an obvious source may be the presentation of a urinary tract infection, especially in infants.

PDF

⬇ Download lesson summary

Downloadable PDF pending upload.

Practical algorithm

Non-retractile foreskin in a young child, without scarring or complications → probably physiological → do not force.
Retracted foreskin that cannot be returned + edema → paraphimosis → emergency.
Testicle outside the scrotum after the first months of life → refer → do not wait years.
Painless, fluctuant scrotal swelling → consider communicating hydrocele.
Adolescent with varicocele → assess testicular development and volume.
Infant with fever without a source → consider urinary tract infection.
Recurrent febrile UTI → assess the need to investigate urinary anomalies/VUR.
Sudden testicular pain → urgently rule out testicular torsion.

In Pediatric Urology, the primary care physician does not need to resolve every condition: they need to distinguish the physiological from the pathological, and recognize when to observe, when to investigate, when to refer and, above all, when to act urgently.

Clinical case

Content pending upload Progressive clinical case focused on decision-making.

Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

References

Links pending upload References to PubMed, DOI, scientific society guidelines and journals.

Urinary tract infections in children