Double Ureter

[Michelle]

My daughter is 5 years old and has been diagnosed with a double ureter. Last year after severe infections, a VCUG showed a grade 3 reflux.  She was put on antibiotics.  This year she showed a grade 2 reflux.  With no break throughs during the year. My urologist says that there is some subjectivity to this reading and that her chances of outgrowing this significantly drop due to the double system.  He says the decision of what to do is strictly up to me, however he kind of leans toward another year of antibiotics.  I am not sure of this because everyday, even to the point of awakening her at night, she says that her tummy hurts in the area of her reflux.  My physician thinks that it is just dicomfort from the reflux itself that she is feeling, but it keeps me in a constant state of worry that she may be getting infected again.  We test her regularly and she is clean.  I am concerned about her living in discomfort for another year and the stress that it has on me when I have other children to care for also.  Also having to do the VCUG again, which has been painful in itself. Do you have any recommendations as to which route I should take?

[HFHS M.D.-BE]

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Dear Michelle,
The usual routine for treatment of urinary reflux is to go on long term prophylactic antibiotics.
There is a good chance that a grade 2 or 3 reflux would resolve over time without any need for corrective surgery.  The patient, however, needs to be on antibiotics to prevent infection, since this( infection) could cause renal scarring, which in turn contributes to deterioration of renal function. As the child grows and follow-up evaluation reveals the resolution of reflux, it is possible to stop the antibiotics and hope that no more infections would result.  If the patient develops breakthrough urinary infection while on antibiotics, or after antibiotics were discontinued, surgical repair may have to be considered.  The option of restarting a different antibiotic is also a possibility.
As far as the pain, it is possible to have pain due to reflux, but this usually manifests itself during the act of urination, but not every time. Further, this pain should not cause a major disruption of lifestyle. Alternatively,  in a duplicated system ( a system with two ureters) there could be reflux in one part of that kidney (usually the lower half), and obstruction in the second part of the kidney (usually the upper half), each of which is drained by one of those two ureters. The obstructed part could potentially lead to pain and discomfort also. To ellucidate this fact, a nuclear renal scan may be performed.  
Additionally, your daughter may be having side effects from the medicine, causing her pain.
The alternative to prophylactic antibiotics would be corrective surgery, which has its own indications and set of risks and benefits.
Further, VCUG is an integral part of the work up and follow up to assure that reflux is not present.
You need to discuss these issues with your urologist. Regardless, if the final outcome includes antibiotics, that would  be an acceptable choice.

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 urban campuses by calling  (1 800 653 6568).

Sincerely;
HFHS-M.D. BE
* Keyword: vesivoureteral reflux

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