Irene Mutua, Osawa Francis, Kuria Kihiko, Lessan Joel
University of Nairobi, Kenya.
University of Nairobi, Kenya.
J Pediatr Urol. 2021 Aug;17(4):518.e1-518.e5. doi: 10.1016/j.jpurol.2021.04.012. Epub 2021 Apr 28.
Children who have undergone urethroplasty procedure for hypospadias are at a higher risk of getting urinary tract infections (UTI). This may be due to urethral scarring following urethroplasty that acts as a nidus for UTI. The risk is also attributed to urine stasis due to complications of urethroplasty such as urethral diverticulum, urethral stricture, meatal stenosis or breakdown of urethroplasty. Hypospadias is associated with mullerian duct remnants such as mullerian duct cysts and enlarged prostatic duct utricle which may lead to recurrent UTI.
To determine the magnitude of urinary tract infections after urethroplasty for hypospadias in children at Kenyatta National Hospital (KNH), a tertiary hospital in Kenya.
This was a prospective descriptive cross-sectional study of male children with hypospadias who had undergone urethroplasty between January 2014 to December 2018 (5years) at KNH with age range from 6 months to 18 years. Appropriate urine collection method was used to obtain the urine specimen for microscopy, culture and sensitivity tests. Data collected was analyzed using STATA 15. Significance of the results was considered at 95% confidence interval.
The total number of patients seen and urine samples collected was 83 boys. The prevalence of UTI following urethroplasty for children with hypospadias was 6% (5/83). They all had UTI symptoms. Of the patients who had UTI, 60% was due to Enterobacter coli, 20% Pseudomonas aeruginosa and 20% Enterobacter cloaca complex. E.coli was 100% sensitive to nitrofurantoin, amoxicillin/clavulanic acid and cefazolin while 33% resistant to ciprofloxacin and Trimethoprim/sulfamethoxazole. Majority of the patients with UTI (80%) had penoscrotal hypospadias and 60% of them developed complications post-operatively.
Urinary tract infections is not a common finding in children who have undergone urethroplasty for hypospadias at KNH. Patients with penoscrotal hypospadias appears to be at a higher risk of developing UTI in our institution with E. Coli being the commonest bacteria implicated. Antibiotic protocol should be based on local culture and sensitivity pattern.
接受过尿道下裂尿道成形术的儿童患尿路感染（UTI）的风险更高。这可能是由于尿道成形术后的尿道瘢痕形成，成为尿路感染的病灶。这种风险还归因于尿道成形术的并发症，如尿道憩室、尿道狭窄、尿道口狭窄或尿道成形术破裂导致的尿液潴留。尿道下裂与苗勒管残余有关，如苗勒管囊肿和前列腺囊扩大，这可能导致复发性尿路感染。
确定肯尼亚三级医院肯雅塔国家医院（KNH）中接受尿道下裂尿道成形术的儿童尿路感染的发生率。
这是一项前瞻性描述性横断面研究，研究对象为2014年1月至2018年12月（5年）在KNH接受尿道成形术的尿道下裂男童，年龄范围为6个月至18岁。采用适当的尿液采集方法获取尿液标本进行显微镜检查、培养和药敏试验。收集的数据使用STATA 15进行分析。结果的显著性以95%置信区间考虑。
共诊治患者并采集尿液样本83例男孩。尿道下裂患儿尿道成形术后尿路感染的患病率为6%（5/83）。他们均有尿路感染症状。在患有尿路感染的患者中，60%是由大肠埃希菌引起的，20%是铜绿假单胞菌，20%是阴沟肠杆菌复合体。大肠埃希菌对呋喃妥因、阿莫西林/克拉维酸和头孢唑林100%敏感，而对环丙沙星和甲氧苄啶/磺胺甲恶唑耐药率为33%。大多数尿路感染患者（80%）患有阴茎阴囊型尿道下裂，其中60%术后出现并发症。
在KNH接受尿道下裂尿道成形术的儿童中，尿路感染并不常见。在我们的机构中，阴茎阴囊型尿道下裂患者发生尿路感染的风险似乎更高，大肠埃希菌是最常见的相关细菌。抗生素方案应基于当地的培养和药敏模式。
