Bilateral Urinary Reflux

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       My son was born 10/97.  In 11/97, he developed a UTI.  He spent 8 days in the hospital on IV antibiotics.  His diagnosis was Bilateral Urinary Reflux.  He was put on Bactrim and still is taking it once a day.  He has had 2 VCUG's.  The first in 12/97, determined his reflux at stage 2.  His recent test showed his condition to have worsened to stage 3.  My son's Urologist feels that by this time next year he will need corrective surgery.  He feels the reflux is going to worsen over time and for us to prepare for the need of surgery.  My son is 1 year old and except for the UTI in 11/97, he has not had another infection.  How can surgery be inevitable if he is not chronically getting infections? We are concerned of putting him through unnecessary surgery.    
      
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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 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. Reflux often resolves with time however it is imperative that he remain on antibiotics until that time. Otherwise, he will encur renal scarring and subsequent renal damage. The likelihood that the reflux will resolve diminishes with age. Also higher grade reflux diminishes the chances that the reflux will resolve. Grades 1 and 2 are low  and Grades 3 to 5 are high . Most pediatric urologists perform surgery to correct the reflux at age 7 to 8 and older because studies have demonstrated that if the reflux has not resolved by that time, it is unlikely to ever resolve..However there are   other reasons to perform surgery  which include infections in spite of taking antibiotics, high grade reflux or decreasing renal function.In the absence of intercurrent infections, it is safe to wait to see if the reflux will resolve with the knowledge that bilateral grade 3 reflux is unlikely to do so.
Surgery of both ureters is required when the child has  persistent breakthrough infections. Some pediatric urologists fix both sides even if only reflux was seen on only one exam . This procedure is very safe and is one of the most common performed by pediatric urologists. In your case there is documented higher grade reflux on both sides therefore both sides need to be repaired. 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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