Questions posted in the
The Urology Forum have been answered by urologists from Henry Ford Health System and by Dr. Kevin Pho.
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Subject: Re: Reflux My daughter was dx'd with bilateral vesicoureteral reflux at 6 months of age. She had 4 kidney infections and was hospitalized twice with IV antibiotics. She is seen yearly to monitor her reflux and now, at age 4.5, she has been infection free since March of 96. At that time, her tests showed the reflux had resolved. Her antibiotic (prophylactic Bactrim) was discontinued. Two weeks later she developed another kidney infection, which let to some slight kidney damage. In Feb. of 98, her Nuclear Cystogram still revealed bilateral reflux, but with the Grades lower than before: 1 and 2. Today, she is maintained on Bactrim daily and her urine contained trace amounts of protein and blood. The nurse said not to worry and to wait until Feb. 99 to get her checked out again. The nurse also said my daughter could still grow out of it, too. My question concerns if it is okay to wait til Feb of 99 for more
______ Dear Tanja, I know it is very concerning to follow your daughters situation, seeing her do so well and then relapse. The fact that she did not have break through infections is good news and perhaps she made stay on prophylactic antibiotics for a more substantial length of time. The fact that her last infection may have lead to some damage of her kidney is unfortunate, however this helps you understand why her doctors have decided to put her back on long term antibiotics. The reason to allow some time before performing another radiologic study is to allow the kidney to continue to grow and this time period will allow the doctors to comment on how she is progressing. If they were to do another radiologic study(most likely an ultrasound) without allowing time to pass, they would most likely be reiterating exactly what her previous films or studies have already told you. Now, if she has another infection in the interim, then of course, imaging the kidneys would be appropriate. Your other question of will she grow out of this condition or should you proceed with surgery. There are several studies that have shown that the majority of patients with grade one and grade two reflux will grow out of there disease particularly if they are identified at an early age. This seems to be the case with your daughter and why your pediatric Urologist has not been more persistent about surgery. The bottom line is that we all want to preserve as much renal function for your daughter such that she can grow and have a normal life. This is the reason for the antibiotics. Some doctors believe that only reflux of infected urine will cause renal damage, whereas other physicians believe that chronic reflux of even sterile urine while have a detrimental effect on growth. I dont know who is right or wrong but I think your daughter is being managed appropriately as long as she is back on the prophylactic antibiotics. Your last question about collagen injection. Urologists, have tried different types of procedures to keep urine from refluxing back to the kidneys. This procedure I think you are referring to is called the Bee Sting procedure. This would involve injection of collagen around the ureteral opening inside the bladder to close the orifice ever so slightly. This would allow urine to flow out into the bladder but prevent it from refluxing. This and other similar procedures may work only temporarily. We have a patient in our institution who has had this done 4-5 time and now he is in his late twenties. The problem with this procedure is that the collagen gets reabsorbed by the body over time and the once narrowed opening returns to its previous state after a year or two. I dont know if I helped you with this information, however I think you are getting good information and you should trust the doctors who are taking care of you daughter. This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568). Sincerely, tests? Will my daughter grow out of this? We have avoided
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