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Various Concepts in the Aetiology of Recurrent Urinary Tract Infections in Girls
Abstract
Parents, patients and practitioners referring cases are often highly critical in their attitude and reluctant to have various diagnostic procedures instituted for the proper evaluation of recurrent urinary tract infections. Repeated follow-up examinations and protracted treatment prescribed are often frowned upon or completely ignored. It is also not generally realised that chronic pyelonephritis is more often a slow, insidious process. It is human to expect a quick solution to our problems, but in the great majority of cases it is of very little use in the long run to treat repeatedly the result of a urine culture and sensitivity without proper diagnostic evaluation. In this article an attempt is made to give a clearer insight into this vast and complex problem of recurrent urinary tract infections in female children and young girls, with special reference to some of the more controversial concepts of various possible aetiological factors. It is admitted that it is often difficult for even the most experienced urologist to keep a balanced appreciation of what is fact or mere fantasy; parents and their private doctors are sometimes also the victims of interprofessional rivalry. In a general classification of urinary tract infections one can state that infections are perpetuated by the following factors: 1. Foreign bodies, i.e. stones. This is, however, very rare in Western countries and will not be discussed. 2. Inability of the urinary tract to empty itself completely. Under this heading we find: (i) obstructive lesions - the urinary tract above the obstruction cannot empty completely; (ii) neurogenic lesions-ineffective detrusor function leaves residual urine in the bladder; (iii) vescioureteric reflux-part of the bladder urine flows back into the ureter and renal pelvis. This infects the kidneys, and when the refluent urine returns to the bladder, the bladder infection is perpetuated. 3. Various forms of vulvovaginal irritation, infection, or anomalies. This article will be published in 3 parts. In part I some concepts regarding possible obstructive lesions and neurogenic lesions will be discussed.
