Urinary tract infections are very common in children and many times go unrecognised which may lead to irreversible kidney damage in the form of scars, early hypertension and even failure after many years in untreated cases. Many times children present with the common childhood symptoms like fever, irritability, frequent urination, difficulty, burning while passing urine or even frank pus in urine.
One should always actively suspect and investigate for urinary tract infection in children in any case of fever illness. These are quite common in girl children. One of the most important aspects of identifying the urinary tract infection is simple urine examination for pus cells. If there are more than 5 pus cells per field on microscopy, then urine culture should be done. It is very common to see that the urine is not collected properly for urine culture test and the laboratory gives urine culture positivity and that leads to confusion and unnecessary treatment.
What is the right technique to collect urine for a test?
Correct way of collecting urine for culture test: Early morning sample is the best. In boys, the skin at the tip of penis (prepuce) should be gently retracted, washed thoroughly with simple soap and water and wipe it dry. When the child passes urine the first few millilitres of urine should NOT be collected and the middle part of the urine specimen should be collected in a sterile container and handed to the laboratory for testing.
Similarly in girls, the private parts should be cleaned thoroughly with soap and water, should be dried and the child is encouraged to pass urine. First few millilitres of urine should be discarded; middle part should be caught in a sterile container for testing.
There are some techniques which doctors follow like catheterized specimen from bladder or needle aspirated urine from urinary bladder etc. but they are very rarely needed.
What if the urine culture is positive?
If the urine is positive for infection on culture test, appropriate antibiotics should be given in consultation with the Pediatric Surgeon. Doctor also would like to rule out deep seated and significant causes in the Urinary tract by doing tests like Ultrasonography, cystourethrogram or even nuclear medicine scans and treat appropriately.