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Urology (Expert Forum)
vesicoureteral reflux
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
vesicoureteral reflux
by stacy, Aug 21, 1999 12:00AM
My daughter is 5 months old and was diagnosed with reflux when she was 3 months. She has had a kidney ultrasound and a voiding cystogram. Our urologist diagnosed her as having grade 2 on the right and grade 3 on the left. He is recommending antiobiotic therapy instead of surgery to see if the problem will correct itself as she gets older. We recently went for a 2nd opinion with a different urologist. She took one look at all the x-rays, and immediately said that she had grade 3 on the right, and grade 4 or 5 on the left. She is recommending that we get a DMSA and a cystoscopy. She believes that our daughter needs surgery right away, but that we may be able to hold off until she's 18 months old depending on the outcome of those two tests. She has had no infections- no symptoms of any kind.
(This problem was actually diagnosed in utero, as her kidney appeared to be dialated in one of my ultrasounds when I was pregnant.)
I have several questions: 1) Is it common for two doctors to look at the same x-rays and come up with different diagnosis?
2) Do you think the DMSA and/or the cystoscopy is necessary?
3) If she does have a grade 4 or 5, do you think surgery is necessary even though she has had no infections? I read in one of these postings that bilateral reflux only corrects itself 9% of the time. Is this true? If so, maybe regardless of what grade of reflux she has surgery would be recommended. 4) Do you recommend having her urine tested at her pediatric check-ups? If so, what exactly are they testing for? Infected urine?
Thank you so much for answering these questions. As you can imagine, we were quite disturbed at the 2nd opinion we received, since it differed so greatly from the first!
(This problem was actually diagnosed in utero, as her kidney appeared to be dialated in one of my ultrasounds when I was pregnant.)
I have several questions: 1) Is it common for two doctors to look at the same x-rays and come up with different diagnosis?
2) Do you think the DMSA and/or the cystoscopy is necessary?
3) If she does have a grade 4 or 5, do you think surgery is necessary even though she has had no infections? I read in one of these postings that bilateral reflux only corrects itself 9% of the time. Is this true? If so, maybe regardless of what grade of reflux she has surgery would be recommended. 4) Do you recommend having her urine tested at her pediatric check-ups? If so, what exactly are they testing for? Infected urine?
Thank you so much for answering these questions. As you can imagine, we were quite disturbed at the 2nd opinion we received, since it differed so greatly from the first!
Doctor's Answer
by hfhs M.D.-AK, Sep 02, 1999 12:00AM
Dear Stacy,
It sounds like your child has vesicoureteral reflux. One doctor may read the films differently than another when it comes to grading reflux. I think slight differences between grades 3-4 should not influence your decision to proceed with conservative management or surgery. The most difficult decision regarding a child with vesicoureteral reflux is deciding between medical and surgical management. Spontaneous disappearance of reflux is related to the age of the child and degree of reflux. It sounds like you have read one of my earlier answers, but I will repost the statistics again. It has been reported that 63% of grade two, 53% of grade three , and 33% of grade four reflux patients have resolved spontaneously if infection is controlled. Another study showed that in children of growing age that unilateral grade four reflux had spontaneous resolution 61% on the time, where as in bilateral patients resolution occurred in only 9%. Reflux that persists in adolescence or adulthood is unlikely to disappear spontaneously. Remember these are studies. Different researchers get different results all the time, although the numbers I presented are fairly consistent with other studies.. I always tell people that if the reflux is severe, grades 4 or 5, surgery should be seriously considered because chances are that the reflux will not resolve. However, a trial of antibiotics is certainly acceptable with follow-up studies to re-evaluate interval changes. If at anytime a break through infection occurs or reflux persists for many years, surgery should also be strongly considered.
A renal scan will tell you the function of the kidney and help look for scars. Since your child hasn’t had any urinary tract infections, a renal scan may not be necessary. If you want to document a base line study, this would be your physicians choice.
I don’t think you should be overly concerned and the two doctors are both correct with there analysis of the situation. Depending on how the films are read makes the difference in the treatment recommendations
The information provided in this forum is presented for general educational purposes only. Specific questions you have pertaining to your health should always be directed to your personal physician.
Sincerely,
HFHS M.D.-AK
*keyword:Reflux
It sounds like your child has vesicoureteral reflux. One doctor may read the films differently than another when it comes to grading reflux. I think slight differences between grades 3-4 should not influence your decision to proceed with conservative management or surgery. The most difficult decision regarding a child with vesicoureteral reflux is deciding between medical and surgical management. Spontaneous disappearance of reflux is related to the age of the child and degree of reflux. It sounds like you have read one of my earlier answers, but I will repost the statistics again. It has been reported that 63% of grade two, 53% of grade three , and 33% of grade four reflux patients have resolved spontaneously if infection is controlled. Another study showed that in children of growing age that unilateral grade four reflux had spontaneous resolution 61% on the time, where as in bilateral patients resolution occurred in only 9%. Reflux that persists in adolescence or adulthood is unlikely to disappear spontaneously. Remember these are studies. Different researchers get different results all the time, although the numbers I presented are fairly consistent with other studies.. I always tell people that if the reflux is severe, grades 4 or 5, surgery should be seriously considered because chances are that the reflux will not resolve. However, a trial of antibiotics is certainly acceptable with follow-up studies to re-evaluate interval changes. If at anytime a break through infection occurs or reflux persists for many years, surgery should also be strongly considered.
A renal scan will tell you the function of the kidney and help look for scars. Since your child hasn’t had any urinary tract infections, a renal scan may not be necessary. If you want to document a base line study, this would be your physicians choice.
I don’t think you should be overly concerned and the two doctors are both correct with there analysis of the situation. Depending on how the films are read makes the difference in the treatment recommendations
The information provided in this forum is presented for general educational purposes only. Specific questions you have pertaining to your health should always be directed to your personal physician.
Sincerely,
HFHS M.D.-AK
*keyword:Reflux
