Recurrent UTIs in boys: When should you worry?

A UTI can be a sign of a greater problem in boys

We tend to think of urinary tract infections, or UTIs, as a predominantly female problem — and it’s true that they tend to be much more common in girls. This is largely due to their anatomy, which can make it easier for bacteria — typically E. coli from the colon — to enter the urethra, bladder and other parts of the urinary tract. Yet even though they’re much less likely to develop these infections, boys aren’t immune from UTIs.

While uncomfortable, most UTIs resolve with a course of antibiotics and home care measures such as increased fluids. For some children, however, UTIs are an ongoing problem: Just when you think the infection has been successfully treated, another one develops. “UTIs can signal an underlying structural problem or blockage, especially in boys,” explains Dr. Richard Yu, a pediatric urologist in the Department of Urology at Boston Children’s Hospital “So it’s important for parents to know what to look for and when to bring their child to a urologist.”

Ongoing problem, underlying issue

Isolated UTIs in boys are generally the result of hygiene issues, such as not properly retracting the foreskin to clean the penis if they are uncircumcised. Yet some boys may experience recurrent UTIs, even if they practice excellent personal hygiene. In these cases, a problem related to the structure of their urinary tract could be to blame, says Yu. Obstructions or blockages can occur in the urethra, bladder, ureters or kidneys and can make it difficult for urine to flow properly through the urinary tract. This can make it difficult to clear bacteria from the urinary tract, leading to recurrent UTIs and possibly kidney infections.

In teenagers and men, kidney stones or an enlarged prostate are usually responsible for an obstruction. But in younger boys, obstructions are most often caused by structural abnormalities in the urinary tract. For example, about 1 in 8,000 boys are born with anterior urethral valves or posterior urethral valves, extra flaps of tissue in the urethra that block the normal flow of urine.

Seeing a specialist

Left untreated, PUV and other types of urinary tract obstructions — such as blood clots, tumors or birth defects called ureteroceles — can lead to severe hydronephrosis, or kidney swelling. Boys with PUV are also at risk for complications including bladder dysfunction and kidney impairment or failure. About half of boys with PUV will also develop vesicoureteral reflux, which can cause urine to move backward into the ureters and kidney, increasing the risk of recurrent UTIs and possible kidney damage.

Parents should watch for signs and symptoms of UTIs, such as frequent or urgent urination, pain during urination, new onset of bedwetting or daytime accidents, foul-smelling or bloody urine, persistent back or abdominal discomfort, fatigue and fever. In babies, irritability, poor feeding and a fever may be the primary symptoms of a UTI.

“To successfully prevent and treat recurrent UTIs, we need to determine what’s going on structurally in your child’s urinary tract,” says Yu. If your child is experiencing ongoing problems with UTIs, it’s worth asking your pediatrician for a referral to a pediatric urologist. This specialist will ask questions about your child’s symptoms and medical history and may recommend tests such as a kidney ultrasound or voiding cystourethrogram. These tests produce images of your child’s urinary tract and can help identify structural causes of recurrent UTIs.

“Treatment options depend on the information obtained about your child from his history and imaging. It may be as simple as observation with ultrasound imaging or preventative antibiotics, or may require surgical treatment,” says Yu. “Proper diagnosis and treatment by a pediatric urologist with experience in these rare conditions can significantly reduce the risk of recurrent UTIs and may prevent kidney damage.”

Learn about the Department of Urology.