Questions posted in the The Urology Forum have been answered by urologists from Henry Ford Health System and by Dr. Kevin Pho.

Question Title: upj obstruction and reflux

Forum: The Urology Forum
Topic: Pediatric Urology

Posted by Christi Chambers on June 10, 1999 at 11:32:22

My son is two years old. He was diagnosed with upj obstruction (lft kid.) inutero. After his first renal scan, he was also diagnosed with reflux (rt kid). He had surgery for this at 9 months of age. We were told the surgery went well. In his first scan after the surgery we were told that the reflux was actually present in both kidneys. It was grade 3 reflux. He was put on septra daily. At first he took it every day, but got thrush, we then went to every other day.
Last week, he had a VCUG and renal ultrasound. The radiologist told us that there was no reflux present. We had been told that he could possibly "grow out" of the reflux. Is it possible that he has already done so at only two years of age?
My main concern is that his urologist has told us he will need to continue having these tests throughout his life to check his kidneys. Is this really necessary? They are so traumatic for him. In fact before this last test, he was toilet trained--and now we are back to "square one" having to start training all over.
Any information you can give or resources you can point me towards will be greatly appreciated.

Posted by HFHS M.D.-BE on June 29, 1999 at 10:22:18


=
Dear Christi,
From what you have described in the beginning of your question about the surgery performed on your son, I just have to assume that he underwent surgery only for the UPJ obstruction and not for the reflux. It is possible for reflux to be present but not be picked up by a VCUG, which is the case here , where the reflux on the left side was not seen on the first study. Regardless, the course of therapy is as you described, i.e., prophylactic antibiotics until reflux is resolved, unless a breakthrough febrile( associated with fever) urinary tract infection or pyelonephritis( infection involving the kidney tissue itself) occurs. In such a case re-implantation surgery may be considered. In your case, fortunately things have gone on a desired course.
It is possible to "grow out of reflux", as you said, especially in grade 3 or less reflux. It is, however, difficult to be sure at what age this happens, and it is variable in different individuals, but at your son's age it may be a bit premature to assume complete resolution of his reflux.
As far as the need for continued testing, it is of crucial importance to do them, so proper measures could be taken if necessary. Your son, however, may not need to have VCUG all the time. If on the next set of studies(next year) no reflux is present , your urologist may choose to follow him up with yearly ultrasound only, unless a breakthrough infection occurs in the interim.
The reversion from being toilet trained to not being toilet trained, in such circumstances is not unusual, and will resolve, especially since your son is only two and has plenty of time to overcome this issue. A urinalysis to rule out infection should be performed. The best of luck to you.

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,
HFHS M.D.-BE
*keyword: UPJ/Reflux



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