Childhood UTI: shorter oral courses, less prophylaxis, and see the febrile child within 72 hours

The edition in brief

Today's urology edition ends on childhood urinary infection. Five systematic reviews of 60 studies, published as the technical report behind the American Academy of Pediatrics' 2026 guideline, found low to very low certainty evidence that courses of seven days or fewer do not raise recurrence and cut adverse effects, that oral antibiotics may work as well as parenteral, that continuous prophylaxis in reflux or bladder and bowel dysfunction may not reduce breakthrough infection or scarring but may increase resistant infection, and that evaluation within 72 hours of symptom onset was associated with less renal scarring. In a phase 2 trial of 253 men, PSMA-PET-guided radiotherapy intensification did not improve the primary failure-free survival endpoint at five years (66% vs 62%), though biochemical control favoured it in the high-risk and post-prostatectomy strata. A prospective lymphangiography study of 40 men with symptomatic lymphoceles after prostatectomy traced 98% of leaks to the region of Cloquet's node. English data on 17,738 patients with kidney cancer showed timely surgery falling from 84% to 65% for high-risk disease between 2019 and 2023. A trial of 72 patients found nefopam reduced moderate to severe catheter-related bladder discomfort after TURBT. The pearl is collecting urine properly in a febrile child.