Vesicoureteral Reflux - corrective surgery

[MiaIShook]

My daughter is just over 6 1/2 yrs and healthy.  She was diagnosed with grade 3 reflux on both sides at 6 mos.  She has been on prophylactic antibiotics since then, with only one break through infection.  Her most recent VCUG (April 2003) shows that there has been no change in her condition since the diagnosis.  Our pediatrician referred us to a Urologist's care.  The Urologist had an ultrasound done (her only other was at 6mos). He said that her left kidney is slightly larger but that both are in good health.  He also advised me that she has a "duplicated collection" that must be "complete" since the reflux does not reach the upper pole, only the lower.  This was never mentioned to us before.  He indicated that this could potentially prolong the process of growing out of the reflux.    He said we have 3 options, to stay on the meds and wait, to fix it with surgery or to stop the meds and see how she does.  His recommendation, given how her condition has "presented itself" to date, is to fix it with surgery.  Two 1/2 yrs ago we were told by another urologist that if she had not improved yet, she probably wouldn't and we should do surgery.  At that time, our pediatrician asked us to get another opinion.  Two other urologists suggested that we wait and so we decided against surgery. Now, my husband and I are not sure what to do.  I would like to know what potential risks are involved with doing surgery and whether or not making the decision to do surgery at this point is appropriate or should we wait?

[Kevin Pho, MD]

Without examinination, I cannot make one recommendation over another, but here are some comments of medicine vs surgery from UptoDate.

Both medical and surgical management of severe reflux appear to be of roughly equal efficacy and choosing between these options is dependent upon clinical judgment. Medical therapy in such children includes daily prophylactic antibiotics which are usually continued until the reflux resolves (as determined from annual radionuclide cystography) the child reaches the age of five to seven, the time at which repeat infection, if it occurs, is unlikely to produce new scars.

Surgical correction of VUR should be individualized and is probably indicated in the following settings:

- The presence of gross reflux and ureteral dilatation in a young child (particularly if under two years of age) even without marked scarring, since new scars will develop in up to 60 percent of these cases.
- A child who becomes infected and shows new scars because of incomplete compliance with medical therapy.
- A family that elects surgery, because compliance with daily antimicrobial therapy is too difficult to achieve or adequate follow-up is difficult for geographic reasons.

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.

[RanaPooh]

A related discussion, Worried Mother was started.