Question Title: vesicoureteral reflux for the past 4 years

My daughter was diagnosed with a Grade II bilateral refulx in August of 1994. At that time she was 3 years old. Since that time she has had VCUG's and ultrasounds yearly with no change in the diagnosis. She also has taken Bactrim and Macrodantin antiobiotics since the diagnosis in 1994. She has also not had any breakthrough infections. She also has CBC's regularly. We take her to a urologist here in our home town and have also seen a Dr. Joseph at the Children's Hospital in Birmingham, Alabama about two years ago regarding her condition. It is my understanding that there are some experimental non-surgical corrective procedures currently being tried. My questions are: How long do you wait before any further steps should be taken to correct this procedure? What if this condition does not correct itself or a corrective procedure is not done? What are some of the new experiments and how safe and efficient are they? Help!! Thank you for your time, Cindy
--------------------------------------
Dear Cindy,
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. The diagnosis of reflux must be made to attempt to prevent this damage. The evaluation of a child with recurrent UTI’s 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. Reflux often resolves with time however it is imperative that she remain on antibiotics until that time. Otherwise, she may incur renal scarring (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 her case. This procedure is very safe and is one of the most common performed by pediatric urologists. The cure rate is greater than 98 %.
Experimental procedures have been tried at several institutions the most promising is injection of material such as silicone particles, collagen and Teflon. Although the cure rate is between 80 to 90 % and the results of these procedures have been encouraging, some of these agents are not known to be long lasting and some of the substances injected have been known to migrate to other parts of the body. Long-term recurrence of reflux is unknown. Several institutions in the US are performing injection procedures for reflux in clinical trials. In the Northeast, Harvard University in conjunction with Boston Children’s Hospital has done a significant amount of work in this area of research.
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

---