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Reflux and UTI

  : Hi!
  : My daughter, age 5 1/2, was diagnosed with grade 2 reflux after a voiding cystogram (sp!) this past August.  In the year prior to that, she was diagnosed with 5 different UTI's.  Each time she was put on different antibiotics.  Since August, she has been on prophylactic antibiotics.  She has had 4 separate breakthrough infections in these few months.  After the third, her Urologist told me he would perform the corrective surgery if she had another.  The last one was two weeks ago.  She had an e-coli count of 10,000 with a fever that peaked at 105.5 about every 3 hours, until I gave her the next dose of fever reducers.  The fever lasted 4 days.  What keeps happening is that she develops a UTI which is insnsitive to whatever antibiotic she is on, so they switch drugs.  Then she develops a different UTI which is resistant to that antibiotic, so they switch back.  Etc.  She has had problems with frequency in urinating and urgency, and always has slight leakage by day.  It seems I always see her standing somewhere with her legs crossed.  She sleeps wearing a pull-up, and wakes up drenched.  She has so much night-time leakage that her bedding needs to be changed each morning. When she has UTI's, these problems are amgnified.  When we visited the doctor last week, I expected to find out more about the surgery and even possibly schedule the procedure.  Instead, he decided to put her on more medications, continuing the antibiotics and adding an anticholergenic drug and a stool softener.  He seems to think she has some sort of "syndrome" in which her brain and her bladder / bowels are not in tune.  Honestly, I don't believe she has a problem with her bowel movements.  I am concerned with her being on antibiotics for a long period and being exposed to so many different antibiotics.  I fear that she will develop immunities to them.  I am also concerned about her self esteem if we don't get a handle on this.  What do you think?  Also -- I would like to know a little bit more about the surgery itself.  If she does have it, how long of a hospital stay is required?  Thanks for your time!
Your daughter seems to be suffering with recurrent urinary tract infections due to vesico ureteric reflux (VUR).  The urgency, frequency of urination and nighttime bed wetting usually signifies that she is also having some element of detrusor instability (bladder hyperactivity).  This condition can be secondary to recurrent cystitis or may be due to some other cause.  Irrespective of the cause, this entity usually makes the reflux worse by increasing the bladder pressures.  Therefore it is important to document and treat associated instability with anticholenergics and antibiotics (to take care of infections).  After this you should consider surgical correction of reflux.  This information is provided for general medical information purposes only. If you would like to consult physicians at department of Urology, Henry Ford Hospital, they would be interested in taking care of your problem.  They would be most interested in helping you. You can reach them through our toll-free number 1-800-653-6568. We can also arrange local accommodations through this number if this is your need. Please bring any x-rays (not just the reports) as well as any physicians  notes and lab test results that you may be able to obtain. These will help us greatly.
Sincerely;HFHS-M.D. AT
* Keyword: VUR

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