Cystitis: The Daily PANCE Blueprint
A 4-year-old girl is brought to the clinic with painful urination that has persisted for 2 days. Her parents report she cries during urination and only a small amount of urine is passed each time. She has no vomiting, nausea, or fever. Her medical history includes 3 episodes of cystitis since starting preschool a year ago, with the most recent infection treated with trimethoprim-sulfamethoxazole 6 weeks ago. Vital signs are normal. On examination, there is moderate tenderness in the suprapubic region, no back pain, and normal genitalia. A rectal examination reveals normal tone and an abundance of hard stool in the rectal vault. A urine culture shows 100,000 colonies of Escherichia coli. Which of the following most likely contributed to this patient's recurrent illness?
A. Vesicoureteral reflux
B. Poor perineal hygiene
C. Functional constipation
D. Urethral stricture
E. Bladder diverticulum
Answer and topic summary
The answer is C. Functional constipation
Functional constipation is a common cause of recurrent urinary tract infections (UTIs) in children. Constipation can lead to distension of the rectum, which in turn can compress the bladder and result in incomplete bladder emptying. This creates a residual volume of urine that can serve as a breeding ground for bacteria, such as Escherichia coli, leading to recurrent infections. The history of hard stools found on rectal examination supports this diagnosis.
Incorrect Answer Explanations:
- A. Vesicoureteral reflux: While vesicoureteral reflux (VUR) can cause recurrent UTIs, the patient’s history does not specifically suggest this condition, such as a known abnormal voiding cystourethrogram (VCUG).
- B. Poor perineal hygiene: Poor perineal hygiene can increase the risk of UTIs, particularly in young children. However, the key clinical clue here is the presence of functional constipation, indicated by the abundance of hard stool.
- D. Urethral stricture: Urethral stricture can cause obstructive symptoms and recurrent UTIs. However, it is less likely in this scenario without a history of trauma, infection, or instrumentation that might lead to stricture formation.
- E. Bladder diverticulum: Bladder diverticula can be associated with recurrent UTIs due to urine stasis within the diverticulum. However, this condition is uncommon in young children and typically requires imaging for diagnosis, which has not been indicated in this case.
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Covered under ⇒ PANCE Blueprint Genitourinary ⇒ ⇒
