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How to treat UTI in young boys?

Q: My son is 4 years old and has been diagnosed with UTI. He had urine culture test done atleast thrice before and the test has always been negative. His foreskin is just a little tighter than in normal cases. He doesn't have any irritation or pain in the area. His flow is also good and he doesn't strain to pass urine. He has NEVER had frequent fever or vomiting or any other related symptom. The tip is a little reddish now and then during doctor checkups which has been there for quite sometime. For the past one year he has been complaining of abdominal pain. He always says the pain is right at the navel. He is very active and thriving. He has allergic cough for the past 1 year and he has been taking Cetrizine syrup very often, almost everyday. This cough worsens whenever he has cold or fever. We found out that his cough is directly related to milk allergy and citric foods. He was on breast milk until he turned 3 and refused to drink cow's milk. After he turned 3 I forced him to take milk and 3 months after he started to drink a good amount of milk he began to have dry cough. He was given different medications like Actifed but Cetrizine worked the best for him. I don't give him a full dose but even 1 ml is sufficient to stop his cough. He went on nebullizer once due to non-stop coughing. But he doesn't wheeze and his primary complex test came out negative. He was also prescribed Hetrazan by another doctor and 5 days after he took the tablets he started to have abdominal pains. We immediately stopped the treatment. From then on until today he has been suffering from a mild discomfort/pain almost everyday. Is this related to the Hetrazan tablet or is the cough and abdominal pain related to hyper-acidity or is the abdominal pain related to UTI? Now the doctor has advised us to circumcise him. Is it necessary even with first occurence of an UTI? An abdominal scan was done and everything is normal. His stool test had some pus cells (5-8). The E. coli count in urine was 10 power 6 CFU/ml. Is this a recurring problem? I have been told that he might run into kidney problem later in life if not circumcised. I read on the net that circumcised kids also get UTI. Then why do it? Is urine culture test enough to prove it is a case of UTI? Could we repeat the test consecutively to see if the bacteria is recurring again? Please advise me on this issue.

A:If urine culture shows significant E.coli grown in urine, it is a urinary tract infection. In male children we take these infections more seriously than female children and look for some underlying cause. As for circumcision, I am very conservative and avoid doing circumcision. 100% chidren are helped by assisting the opening of prepuce which ultimately mothers can manage easily. If the ultrasound of urinary tract is normal he just needs complete treatment of his urinary infection, dilatation and separation of prepuce and follow up. If he has recurrent infection he would require a careful examination and some more investigations.


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