My three year old is experiencing urinary tract infections and the doctor believes it could be vesicoureteral reflux. He has scheduled an ultrasound.
What is the course of treatement for this and what can be done to correct it? Is this genetic or just a common problem?Question:
The kidney make urine which drains into a tube called the ureter. The ureter allows for the urine to travel to the bladder. When the bladder gets full enough, we get the sensation to urinate which causes the bladder to contract opening a sphincter to another tube called the urethra which carries the urine to the outside world.
Vesicoureteral reflux occurs when the bladder contracts and instead of the urine going down the urethra to the outside world, it travels back up the ureters toward the kidney. The urine goes the wrong way. This can cause a couple of problems:
- The urine while normally sterile may occasionally get bacteria in it(more often in girls). If there is significant reflux (meaning urine travels all the way back up to the kidney), that infection may rapidly spread to the kidney causing both damage to the kidney but also making the person quite sick.
- The urine travelling the wrong way may exert a large amount of pressure on the kidey which can damage it.
There are several causes of reflux. The ureters may not have connected correctly to the bladder when the child was growing as a fetus. The sphincter mechanism which keeps the urine from going the wrong way may not work correctly. There are many variations on this theme but essentially in boils down to the plumbing not being connected correctly and/or not working properly. Other causes involve the bladder not functioning properly.
The evaluation of this requires two types of studies. One type of study is done to both look for any anatomic abnormalities and to look for any damage to the kidneys. This can be done with an ultrasound or more accurately with a DMSA scan. The second study called a voiding cystourethrogram (VCUG) is to look for the actual reflux.
Treatment is based upon how significant the reflux is, if any anatomic abnormalities are present, if there is any damage done to the kidneys, and how many urinary tract infections have occurred. This may range from not doing anything but monitoring (e.g. mild reflux, no damage to kidneys,only a couple of urinary tract infections) to chronic once per day antibiotics (mild reflux, many previous urinary tract infections) to surgery to correct any anatomic abnormalities (severe relux, infections, or damage). 80 percent of children with mild reflux will stop spontaneously as they get older. The most common surgery is disconnecting and then reimplantating the ureters into the bladder so that they function correctly.
Reflux is not an uncommon problem, and it does not seem directly inherited. However, there does seem to be a prevalence in some families such that if one sibling has reflux, another is at greater risk to have it.Answer: