The role of bladder function in the pathogenesis and treatment of urinary tract infections in toilet-trained children

  • Armando J. LorenzoEmail author
  • Mandy Rickard
  • Joana Dos Santos
Educational Review


Urinary tract infections (UTIs) are a common reason for referral to pediatric specialists and the risk profile of these children is influenced by age, sex, and underlying urinary tract abnormalities. UTIs in toilet-trained children represent a different entity than confirmed, febrile UTIs that occur in infants, impacted by suboptimal bladder habits, bladder dysfunction, constipation, or a combination of these factors. A comprehensive literature search was conducted using PubMed and MEDLINE and search terms included recurrent UTI, VUR, bladder and bowel dysfunction (BBD), constipation, lower urinary tract symptoms, and voiding dysfunction. Common presenting symptoms of UTI in children include fever (> 38 °C) with or without “traditional” lower urinary tract symptoms (LUTS) such as dysuria, malodorous urine, frequency, urgency, and incontinence. However, many infections in older children are afebrile episodes—consisting primarily of LUTS—which may or may not be confirmed with biochemical and/or microbiological evidence. Therefore, when evaluating toilet-trained children with recurrent UTIs, it is paramount to consider dysfunctional elimination as an underlying cause, diagnose, and treat it prior to indicating surgical options, even in the presence of VUR or other anatomical abnormalities. Although the impact of bladder function on the risk of infections is important, so is the accurate diagnosis and initial evaluation. This review article will focus on an often overlooked yet critical factor: the impact of bladder function, particularly for toilet-trained children, as well as the importance of implementing bladder training strategies, aggressive management of constipation, and pharmacological management as necessary.


Urinary tract infection Vesicoureteral reflux Bladder dysfunction Bladder and bowel dysfunction Children 



Urinary tract infection(s)


Febrile urinary tract infection(s)


Recurrent urinary tract infection(s)


Lower urinary tract symptoms


Continuous antibiotic prophylaxis


Bladder and bowel dysfunction


Vesicoureteral reflux




Voiding cystourethrogram


Dimercaptosuccinic acid


Urodynamic studies




Post-void residual


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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© IPNA 2019

Authors and Affiliations

  1. 1.Division of Urology, Hospital for Sick Children and Department of SurgeryUniversity of TorontoTorontoCanada
  2. 2.Hospital for Sick ChildrenTorontoCanada

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