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Urology (Expert Forum)
chronic infection - pediatric
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
chronic infection - pediatric
by lindab, Sep 24, 2003 12:00AM
Please help. Our daughter just turned 6. She has had chronic bladder infections for 3 years.
2 years ago she had reinplantation surgery to correct her grade 4 reflux. This has prevented the frequency of kidney infections...but NOT the frequency of her UTI's. She has had every test imaginable....renal scans, mri, vcugs...we time her voiding patterns....she has tried Ditropan and related drugs...and spent 6 months on Cipro as a propholaxis. Unfortuneately...she has many many drug allergies, and almost always Cipro or Gentamycin are the drugs of choice. Her infections vary...sometimes they are gam neg rods...but it is so diverse that we cannot find a pattern. The frequency of these infections are at least every month....and now that she is 6 she is starting to miss a lot of school. The kidney infections are now again starting to happen. She is currently in the hospital with yet another acute kidney infection....This time they grew 3 different bugs. She had another ultrasound yesterday...and they just came back and told us that there is significant change from her last one of 6 months ago. Both kidneys are affected and there is significant swelling in both uretors, the bladder, and the whole region. They want to send her for another VCUG right away. We are prepared to do anything for our child. If it means traveling to the States, or finding an expert elsewhere in the courntry. We have been struggling with this for 3 years....and nothing has helped....and we do not want her to be back on Cipro for another year. We feel that 3 years of Cipro, when it is not even recommended for children is enough. Is there anywhere else we can go....is there anything else we can do.?
We have also been working with a nutritionalist....what are we missing?
2 years ago she had reinplantation surgery to correct her grade 4 reflux. This has prevented the frequency of kidney infections...but NOT the frequency of her UTI's. She has had every test imaginable....renal scans, mri, vcugs...we time her voiding patterns....she has tried Ditropan and related drugs...and spent 6 months on Cipro as a propholaxis. Unfortuneately...she has many many drug allergies, and almost always Cipro or Gentamycin are the drugs of choice. Her infections vary...sometimes they are gam neg rods...but it is so diverse that we cannot find a pattern. The frequency of these infections are at least every month....and now that she is 6 she is starting to miss a lot of school. The kidney infections are now again starting to happen. She is currently in the hospital with yet another acute kidney infection....This time they grew 3 different bugs. She had another ultrasound yesterday...and they just came back and told us that there is significant change from her last one of 6 months ago. Both kidneys are affected and there is significant swelling in both uretors, the bladder, and the whole region. They want to send her for another VCUG right away. We are prepared to do anything for our child. If it means traveling to the States, or finding an expert elsewhere in the courntry. We have been struggling with this for 3 years....and nothing has helped....and we do not want her to be back on Cipro for another year. We feel that 3 years of Cipro, when it is not even recommended for children is enough. Is there anywhere else we can go....is there anything else we can do.?
We have also been working with a nutritionalist....what are we missing?
Doctor's Answer
by Kevin Pho, MD, Sep 26, 2003 12:00AM
, Sep 26, 2003 12:00AM
Unfortunately this can be a frustrating problem. You note that surgery has already been performed as well as chronic antibiotics. Studies have shown that they have roughly equal efficacy and that the decision for either modality should be individualized per patient.
Open surgery is typically used with both nonautologous (Teflon, collagen, silicon microimplants, polyvinyl alcohol, and bioglass) and autologous injectable materials (autologous fat, alginate and chondrocytes, and bladder muscle) being used.
An alternative to open surgery is subureteric Teflon injection (the STING procedure) has been successful in Europe and Japan, but is not approved in the United States. You may want discuss these options with your urologist.
If surgery is not an option, then unfortunately chronic antibiotics would be the most viable option.
To find a urologist in the United States, you can start at this link:
http://www.urologyhealth.com/find_urologist/
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Rose et al. Diagnosis and treatment of vesicoureteral reflux and chronic pyelonephritis. UptoDate, 2003.
Open surgery is typically used with both nonautologous (Teflon, collagen, silicon microimplants, polyvinyl alcohol, and bioglass) and autologous injectable materials (autologous fat, alginate and chondrocytes, and bladder muscle) being used.
An alternative to open surgery is subureteric Teflon injection (the STING procedure) has been successful in Europe and Japan, but is not approved in the United States. You may want discuss these options with your urologist.
If surgery is not an option, then unfortunately chronic antibiotics would be the most viable option.
To find a urologist in the United States, you can start at this link:
http://www.urologyhealth.com/find_urologist/
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Rose et al. Diagnosis and treatment of vesicoureteral reflux and chronic pyelonephritis. UptoDate, 2003.
Member Comments
by SON RICHARD, Nov 29, 2003 12:00AM
To: Cystisis
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