Recurrent urinary tract infections and non-neurogenic neurogenic bladder in children

Abstract A case is presented of recurrent urinary tract infections (UTIs) with frequent findings of post-void residuals in a 5-year-old potty-trained girl. Despite prophylactic antibiotics, breakthrough lower UTIs occurred, and investigations showed upper urinary tract dilatation, bladder wall thickening, but no significant renal parenchymal damage. Urodynamic studies revealed impaired bladder compliance, dysfunctional voiding, and incomplete bladder emptying. A magnetic resonance imaging scan of her spine revealed no intraspinal abnormality. Clean intermittent catheterization was attempted on several occasions, but the patient was very resistant and fearful. Therefore, a suprapubic tube was placed temporarily, with clamp and release during daytime and on overnight free drainage. Following placement of the suprapubic tube, complete resolution of upper urinary tract dilatation and episodes of UTIs occurred. This case illustrates that a simple case of recurrent UTIs turned out to be the most severe form of bladder dysfunction without any clear know pathology.