Voiding dysfunction in children with culture positive urinary tract infection


  • Raeshmi Ramalingam Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
  • Saji James Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
  • Ramesh Babu Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
  • Priyadharshini Rajendran Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India




Urinary tract infections, Voiding dysfunction


Background: Urinary tract infections (UTI) are one of the most common reasons for referral to a hospital. Early identification and prompt treatment will prevent complications associated with UTI. Voiding dysfunction is one of the leading causes of UTI in children. This study aims to assess children affected with UTI using dysfunctional voiding symptom scores (DVSS) and find the relationship between voiding dysfunction and UTI.

Methods: This study was conducted in the Department of Paediatrics, Sri Ramachandra Medical College, Chennai, Southern India. All the children who presented with culture positive UTI between April 2008 and Jan 2011 was prospectively analyzed. USG abdomen and X-ray spine were performed to detect any occult spinal or genitourinary tract anomalies and only those with normal findings were included for the study. Presence of voiding dysfunction was evaluated with modified DVSS score.

Results: Study population consisted of 184 children (age group 6–18 years) with female preponderance (M:F = 1:1.9). The most common isolated organism was E. Coli. Voiding dysfunction was identified in 38% using DVSS score. Voiding dysfunction was higher in girls (47.9%) compared to boys. In those with first episode of UTI voiding dysfunction was found in 43% (56/130). Those with recurrent UTI voiding dysfunction were found in 25.9% (14/54).

Conclusions: Voiding dysfunction was significantly higher in girls compared to boys with UTI. Voiding dysfunction was high even among those with first episode of UTI. It is essential to identify and treat voiding dysfunction in children with UTI.


Yeung CK, Godley ML, Ho CKW. Some new insights into bladder function in infancy. Br J Urol. 1995;6:235-40.

Loening-Bauckev V. Urinary incontinence and UTI and their resolution with treatment of constipation. Paedi. 1997;100:228-32.

O’Regan S, Yazback S, Hamberge B, Schick E. Constipation an unreocgnised cause of enuresis. Am J Dis Child. 1986;140:260-1.

Snodgrass W. Relationship of voiding dysfunction to urinary tract infection and vesicoureteral reflux in children. Urology. 1991;38(4):341-4.

Hjalmas K, Arnold T, Bower W, Caione P, Chiozza LM, von Gontard A, et al. Nocturnal enuresis: An international evidence based management strategy. J Urol. 2004;171:2545-61.

Sripathi V. Voiding dysfunction - A review J. Indian Associate Paediatric Surg. 2005;10(4):229-36.

Ravi Ramamurthy H, Kanitkar M. Recurrent urinary tract infection and functional voiding disorders. Indian Pediatrics. 2008;45:689-91.

Norgaard JP, van Gool JD, Hjalmas K, Djurhuus JC, Hellström AL. Standardization and definitions in lower urinary tract dysfunction in children. International Children's Continence Society. Br J Urol. 1998;81:1-16.

Farhat W, Bägli DJ, Capolicchio G, O'Reilly S, Merguerian PA, Khoury A, et al. The dysfunctional voiding scoring system: quantitative standardization of dysfunctional voiding symptoms in children. J Urol. 2000;164(3 Pt 2):1011-5.

Babu R. Effectiveness of tolterodine in nonneurogenic voiding dysfunction. Indian Pediatr. 2006;43(11):980-3.

Upadhyay J, Bolduc S, Bagli DJ, McLorie GA, Khoury A, Farhat W. Use of the dysfunctional voiding symptom score to predict resolution of vesicoureteral reflux in children with voiding dysfunction. J Urol. 2003;169:1842-6.

Colen J, Docimo SG, Stanitski K, Sweeney DD, Wise B, Brandt P, et al. Dysfunctional elimination syndrome is a negative predictor for vesicoureteral reflux. J Pediatr Urol. 2006;2(4):312-5.

Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol. 1998;160(3 Pt 2):1019-22.

Shaikh N, Hoberman A, Wise B, Kurs-Lasky M, Kearney D, Naylor S, Haralam MA, Colborn DK, Docimo SG. Dysfunctional elimination syndrome: is it related to urinary tract infection or vesicoureteral reflux diagnosed early in life Pediatrics. 2003;112(5):1134-7.

Chen JJ, Mao W, Homayoon K, Steinhardt GF. A multivariate analysis of dysfunctional elimination syndrome, and its relationships with gender, urinary tract infection and vesicoureteral reflux in children. J Urol. 2004;171(5):1907-10.

Coletta R, Olivieri C, Briganti V, Perrotta ML, Oriolo L, Fabbri F, et al. Patients with a history of infection and voiding dysfunction are at risk for recurrence after successful endoscopic treatment of vesico ureteral reflux and deserve long-term follow up. Urol Ann. 2012;4(1):19-23.






Original Research Articles