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Subject: Re: vesicoureteral reflux
Forum: The Urology Forum
Topic Area: Urology - General
Posted by HFHS M.D.-KR on September 08, 1998 at 18:13:57:
In Reply to: vesicoureteral reflux posted by David on September 02, 1998 at 15:21:35:
My daughter is eight years old and was diagnosed with reflux in 1993. At that time she had a UTI and the VCUG study showed a grade 1 refux on the left. She was not treated at that time. In 1995 she had two more UTI's and was started on prophylactic antibiotics. The VCUG then showed grade 2 reflux on the left. In 1996 - grade 3 on left, and grade 1 on right
1997 - grade 2 on left
1998 - had a nuclear cystogram, because I was concerned about the radiation exposure from the VCUG's. The doctor estimated a grade 2-3 reflux on the left.
Her doctor has now recommended surgery to correct the reflux. Do you think we have waited long enough? How much chance do you think there is of the reflux disappearing if we waited another year? We really want to get this taken care of, but do not want her to have surgery unless it is absolutely necessary.
If she has the surgery, would you think she should have both sides reimplanted since she did show the grade 1 reflux on the right at one time? Also, she has not had any breakthrough infections since being on the antibiotics. Thank you.---------------------------------------------------------------------
Dear David,
Urinary tract infections in children are a common problem. Bladder infections alone are not dangerous . However, reflux of urine into the kidney in combination with urinary tract infections can lead to kidney damage. Diagnosis of reflux in childhood must be made to prevent this damage. The evaluation of a child with recurrent UTIs includes a renal ultrasound looking for dilation of the kidney and a VCUG to find reflux.
The VCUG ( Voiding CystoUrethroGram) is performed by placing a catheter in the bladder and instilling contrast material while X-rays are taken. This is a very safe test performed at most hospitals. Your daughter has undergone this exam and was found to have reflux. You were correct in asking that a nuclear cystogram be performed to decrease radiation exposure once the diagnosis is made. This is an excellent examination to follow-up children with reflux. Reflux often resolves with time however it is imperative that she remain on antibiotics until that time. Otherwise, she may incur renal scarring and subsequent renal damage. The likelihood that the reflux will resolve diminishes with age. Most pediatric urologists perform surgery to correct the reflux at age 7 to 8 and older. Studies have demonstrated that if the reflux has not resolved by that time, it is unlikely to ever resolve.
Surgery of both ureters is required in your case. Even though the reflux on the right is low-grade it is unlikely to resolve. Some pediatric urologists fix both sides even if reflux was seen on only one exam ( that is if the other side must be operated upon ).This procedure is very safe and is one of the most common performed by pediatric urologists.
This information is provided for general medical education 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). HFHS MD-KR
*keyword: vesicoureteral reflux
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