Pediatric Urinary Tract Infection Differential Diagnoses

Updated: Aug 01, 2016
  • Author: Donna J Fisher, MD; Chief Editor: Russell W Steele, MD  more...
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DDx

Diagnostic Considerations

Conditions that can produce the symptoms of urinary tract infection (UTI), along with those listed in the Differentials section, include the following:

  • Epididymitis
  • Orchitis
  • Prostatitis
  • Urethritis
  • Pregnancy
  • Urolithiasis
  • Bladder and bowel dysfunction

Children with uninhibited detrusor contractions may experience symptoms of voiding dysfunction (eg, urgency, frequency, hesitancy, dribbling, or incontinence) in the absence of infection or local irritation. In attempts to prevent incontinence during a detrusor contraction by voluntarily increasing outlet resistance, however, these children may promote the development of a UTI. One theory is that bacteria-laden urine in the distal urethra may be milked back into the urinary bladder (urethrovesical reflux).

Increased outlet resistance may be achieved by using various posturing maneuvers, such as the following:

  • Tightening of the pelvic-floor muscles
  • Applying direct pressure to the urethra with the hands
  • Performing the Vincent curtsy, which consists of squatting on the floor and pressing the heel of one foot against the urethra

Voiding dysfunction is not usually encountered in a child without neurogenic or anatomic abnormality of the bladder until the child is in the process of achieving daytime urinary control.

Adolescent girls are more likely to have vaginitis (35%) than UTI (17%).Adolescent girls who are diagnosed with cystitis frequently have a concurrent vaginitis. Pregnancy must be considered in adolescent girls who present with symptoms of UTI and/or vaginitis and who are sexually active.

Differential Diagnoses