Why not surgery instead of long term antibiotics

[Denzel]

My 7 month old daughter has recently being diagnosed with urinary reflux of a grade 3-4 level.  This was discovered after a bad UTI high fevers and a hospital admission for 4 days of IV antibiotics. She is now on oral bactrim until she is well toliet trained with the hope that this condition will right itself during this time.  I have some information that suggests that a grading of 3-5 may needed to be fixed by operating and reimplanting the ureters back into the bladder on an angle that prevents the urine from refluxing back up into the kidneys.

Would it not be better to have surgery initally and avoid the long term use of antibiotics?


I have some concern of the long term use of antibiotics and with this grading I am also concerned that she may need surgical intervention at the end of this time if the condition does not right itself anyway.  

Will she be resistant to this drug should she need it in years to come?  What about the affect on her teeth?  My paediatrican is in favour of the antibiotic approach and I would appreciate a second opinion.
Thank You
Denzel

[Kevin Pho, MD]

Studies have shown roughly equal efficacy between surgical and medical therapy for urinary reflux.  However, surgery is normally considered in the following cases:

* 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.

You may want to inquire about another opinion (preferably at a tertiary care medical facility) to see if surgery is the better option.

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.

Kevin, M.D.
Medical Weblog:
kevinmd_b

Bibliography:
Rose et al.  Diagnosis and treatment of vesicoureteral reflux and chronic pyelonephritis.  UptoDate, 2004.

[IJoeG]

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