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Background The aim of this study was to examine whether toilet-trained children with a history of febrile urinary tract infection (fUTI) and elevated postvoid residual (PVR) urine volume according to a recently published PVR nomogram were at greater risk of UTI recurrence. Materials and methods One month after recovery from febrile UTI, constipation was diagnosed according to the Rome III criteria, and lower urinary tract (LUT) function was evaluated with two sets of uroflowmetry and PVR by ultrasonography. For children aged â¦6 and â§7 years, elevated PVR is defined as >20 and >10 ml, respectively. Cox proportion hazards regression was used to evaluate the risk factors for recurrence of UTI. Results Between 2005 and 2011, 60 children aged 6.5 ± 2.5 years (boy:girl ratio 27:33) were enrolled for analysis. Univariate analysis showed that recurrent febrile UTI was more commonly observed in children with elevated PVR [repetitive elevated PVR: hazard ratio (HR) 5.75, 95 % confidence interval (CI) 1.41-23.4; one elevated PVR: HR 4.53, 95 % CI 1.01-20.2] and high-grade vesicoureteral reflux (VUR; HR 4.53, 95 % CI 1.46-14.07). Multivariate analysis showed that younger age (HR 1.37, 95 % CI 1.03-1.82, p < 0.01) and elevated PVR (HR 2.88, 95 % CI 1.44-5.73, p = 0.01) were significant, independent risk factors for recurrent febrile UTI-but not gender, presence of high-grade VUR and constipation. Conclusion Elevated PVR defined by the new PVR nomogram predicted recurrent UTI in children with history of febrile UTI. Care should be taken to manage children with elevated PVR., Author(s): Shang-Jen Chang[sup.1] [sup.3] , Li-Ping Tsai[sup.2] [sup.3] , Chun-Kai Hsu[sup.1] [sup.3] , Stephen S. Yang[sup.1] [sup.3] Author Affiliations: (1) Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi [...]

Urinary tract infections are commonly encountered and managed worldwide, and emphysematous pyelonephritis (EPN) is among the most serious types of urinary tract infections. EPN is an acute necrotizing infection of the kidney, often associated with high rates of renal loss and mortality. The symptoms of EPN infection can be nonspecific, but the clinical triad of fever, flank pain, and nausea represent the most common presentations. The diagnosis and classification are performed with the assistance of computed tomography (CT). The imaging-based classification system created by Huang and Tseng is widely used in clinical assessments. They defined EPN into four different class (1–4), with the higher number the more severe disease. Optimal EPN treatment is controversial, with emergent nephrectomy suggested during early studies, whereas more recent evidence favors more conservative approaches. Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis are most common pathogens. The initial use of broad-spectrum antibiotics such as Third-or fourth-generation cephalosporins and carbapenems are recommended. Diabetes, obstructive uropathy and hypertension are the most common risk factors and often need treatment together. Emergent drainage is indicated with a larger-sized drainage tube to achieve better drainage function. CT guidance has a better success rate than insertion under the guidance of ultrasonography. Nephrectomy should be reserved as the last resort for those who fail to respond to conservative therapy. This review aims to provide comprehensive, evidence-based recommendations for the diagnosis and management of this life-threatening urological infection. [ABSTRACT FROM AUTHOR]