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
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.
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.
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.
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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Pediatric Urological Surgery
Should Know About