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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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