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Objective To investigate lower urinary tract dysfunction in pre-toilet trained infants with and without history of febrile UTI (f-UTI). Materials and Methods Pre-toilet trained infants with f-UTI (Group 1) from pediatric nephrology and urology clinics, and those without f-UTI (Group 2) from infant-care centers were enrolled for the present study. Infants in Group 1 underwent four-hourly (4-H) observations for at least one month after treatment for UTI. Voided volume (VV) and post-void residual urine (PVR) were measured by weighting diaper and suprapubic ultrasound after finishing voiding, respectively. Average PVR was defined as the mean value of PVR during 4-H observation. Interrupted voiding was defined as two or three voidings within 10 min. Voiding efficiency was defined as VV/(VV + PVR). Results The mean ages of Group 1 ( n = 64) and Group 2 infants ( n = 56) were 10.6 ± 7.5 months vs 10.2 ± 5.1 months, respectively ( p = 0.70). Group 1 infants had significantly higher voiding frequency (3.0times ± 1.2 vs 2.6times ± 0.9, p = 0.04), average PVR (14.5 ml ± 14.2 vs 8.9 ml ± 8.8, p p = 0.01) than Group 2. ROC curve analysis showed that the optimal cutoff values for PVR and voiding efficiency to differentiate Group 1 and Group 2 infants were 10 ml and 80%, respectively. Group 1 infants had significantly more repeat elevated PVR (≧ 10 ml) and repeat low voiding efficiency (≦ 80%) than Group 2 (44.8% vs 22.4%, p = 0.03; 62.0% vs 28.6%, p Conclusion Pre-toilet trained infants with f-UTI were associated with elevated PVR and lower voiding efficiency than normal controls.

Purpose The voiding of healthy newborn boys shortly after term is dominated by dyscoordinated flow patterns (Olsen et al. J Urol in press) and continues to do so during the first year of life (Olsen et al. J Ped Urol 2008). This study addresses the flow patterns of premature boys. Material and Methods The parents of 29 otherwise healthy premature males accepted to let their child participate in the study. Flow measurements were carried out using an ultrasound flow probe device during a 4-hour observation period. Flow patterns were assessed according to the definitions of the ICCS. Data of 25 boys (median gestational age/weight at birth: 31.3 weeks/1590 g) with 98 micturitions where applicable for analysis. Results are reported as median (range). Results On examination median age was 10 (3-42) days. Flow patterns were bell-shaped in 48%, interrupted in 44%, staccato in 6% and plateau in 2%. In nine of the 47 bell-shaped curves (19%) some fluctuations occurred though not fulfilling the criteria of staccato. None of the premies with more than one recorded micturition had bell-shaped curves only. The number of coordinated flows was not correlated to the age (r2 0.016, P = 0.6). Subjects voided 0.7 (0.2-3.6) times/hour with a volume of 3.9 (0.6-25.2) mL. Median Qmax was 1.0 (0.3-10.0) mL/s. Conclusions Male premies void with a high degree of dyscoordination, small volumes and Qmax values indicating incomplete bladder emptying. Dyscoordinated voiding seems to be part of the natural development of voiding function. This study supports the observations made in mature newborns and during infancy showing maturational voiding coordination.