Pediatric Urological Surgery

Reflux of Urine In Children

The bladder fills with urine and when full will contract to squeeze all the urine out through the urethra. Normally, the urine is prevented from going back up the ureters towards the kidneys by a valve-like mechanism located at the junction between the ureters and bladder. When this valve is inadequate and allows urine to flow back up into the ureters, this condition is known as reflux.

Why is Reflux dangerous?

Urinary tract infections usually start in the bladder. In children with reflux, bacteria from a bladder infection may ascent to the kidney's and result in kidney damage. Without reflux a bladder infection may be irritating, but rarely spreads to involve the kidneys. Some of the long-term complications of kidney damage associated with reflux include loss of kidney function and premature development of hypertension.

Which studies are performed to identify Reflux?

Physical examination will not differentiate between normal children and those with reflux. Reflux is best demonstrated by an X-ray study, called a voiding cystourethrogram (VCUG). To perform this study, the bladder is filled through a small soft catheter passed through the urethra into the bladder. X-ray pictures are taken as the bladder fills and empties to check for reflux. The degree of reflux is graded from 1 (mild) up to 5 (severe). Further studies to assess the function and growth of your child's kidneys may include an IVP, renal scan or renal sonogram. Cystoscopy under general anesthesia is very rarely helpful, so we do not recommend it.

Plan of Treatment

Most children have a good chance of outgrowing this condition of reflux, as the area of the ureteral valve matures. To protect their kidneys and allow for this period of maturation, the development of urinary tract infections must be prevented. This can usually be accomplished safely and effectively by prescribing a low dose of antibiotic nightly (for as long as the child has reflux). Follow-up evaluations include: (1) Urine cultures every 2-3 months. A VCUG or nuclear cystogram to check for reflux yearly. Check kidney growth or function with either an IVP, renal scan or sonogram about every 1-2 years. Check your child's height, weight, blood pressure and blood tests every year.

Plan of Treatment

Surgical correction of reflux is required in only a minority of the children. Surgery is recommended when infections recur despite antibiotic therapy, higher grades of reflux (usually 4 or 5), and for those who still have reflux when they reach preadolescence. This type of surgery is highly successful and improves the ureteral valve mechanism by "tunneling" (reimplanting) the child's own ureter into the bladder to prevent reflux. It is important to realize your child may still be susceptible to developing a urinary tract infection even after having reflux corrected. However, the bacteria will remain within the bladder and no longer ascend to involve the kidneys in the majority of cases following reimplantation, avoiding potential kidney damage.

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