The Female Urethra in Recurrent Infections

Abstract

Recurrent urinary infection in girls is perhaps the commonest disorder for which children are referred to the urologist, and despite the numerous reports of varying but apparently successful methods of treatment it remains a sore trial to many. Some of these cases are found to have clearcut anomalies, such as obstruction, reflux or stone, but the majority are radiologically normal or have very questionable abnormalities. In the absence of reflux there is very little evidence that these infections produce any permanent renal impairment, and most are probably confined to the lower urinary tract, yet they are an important cause of recurrent malaise, loss of schooling and of urinary incontinence. In many centres the investigation and treatment of these children occupies a very large proportion of the time and effort devoted to paediatric urology, and whilst paediatricians are apt to treat children conservatively, amongst the urologists there has been a natural bias in favour of instrumental methods or operative management. There has been a widespread conviction that any procedure which widens the female urethra will cure a substantial proportion and investigations often seemed aimed at providing a scientific basis for these procedures. Only in the last two or three years have controlled studies been reported and it must be admitted that a study of the disorder is a difficult one to control: the symptoms are variable and intermittent. Spontaneous improvement is common, collection of specimens difficult and bacteriological standards variable.