Q: My 3-year-old son is having urinary infection. We did his urine culture and found that there was pus and bacterial infection. He is taking antibiotics for it. As advised by the doctor, we got done an IVP test and MCU test to find out any kidney/bladder problem but the test result showed no problem. His PVR test varies between 2cc to 8cc residue. Now, the doctor advised us that make urodynamic test. What is this test? Is it good to do urodynamic test for a 3-year-old boy? Is there any discomfort for baby while doing this test? Please advise.

A:Urinary tract infection in a 3 years male child should be attended to find out a cause. First step is a thorough physical examination, as sometimes as trivial a cause as phimosis (non-opening of foreskin) may cause urinary infections. After the examination, the next step is ultrasonography to find any anatomical defect in urinary tract, which obviously does not seem to be there from your description. Ultrasound examination on the child has not revealed any residual urine (although I must tell you that presence of significant residual urine in children could be absolutely normal). A MCU test, usually done after 3 to 4 weeks of infection episode, has already been done, and has been found to be normal. Frankly speaking, I do not find a justification to perform an invasive investigation like urodynamic evaluation in absence of a finding on MCU or ultrasonography. I would suggest that the child be followed with urine examinations and urine cultures performed on a freshly voided midstream sample. It is not easy to collect a clean mid stream sample in a child. Another mistake is to collect the sample in morning, and delivering it to the lab after couple of hours. Both these situations may result in a false positive urine culture, and unnecessary investigations. Clinicians are sometimes forced to collect urine sample by a supra pubic aspiration or catheter collection to prove or disprove the presence of urinary tract infection.