We obtained a detailed history of voiding pattern in 250 children who developed their first UTI between ages 2-10 yrs.; 92% had more than one UTI. Patients (Pts.) with neurogenic voiding dysfunction and urinary tract obstruction were excluded. Table

Table 1
Full size table

An abnormal voiding pattern was found in all boys and 85% of girls, and it explained their predilection for UTI. The majority of Pts. manifested hyperactive detrusor-sphincter (HDS) i.e. 1, 2, or 3.

Normalization of voiding pattern was obtained in Pts. with HDS by bladder training using motivation, frequent timed voiding, anticholinergics, and attention to rectal emptying. Infrequent voiders were encouraged to void ≥ 5 times a day. Children with frequent UTI or VU reflux were provided antibacterial prophylaxis. At 6 months follow-up, no further UTI was noted in infrequent voiders and in 85% of Pts. with HDS. The cessation of UTI correlated with the achievement of normal voiding pattern. An improvement in stool withholding correlated with improvement in 1, 2, 3 and vice versa.

The detection and correction of the underlying abnormal voiding pattern is the key to the prevention and treatment of UTI in children.