The urinary system is comprised of the kidneys, ureters, bladder and urethra. Normally, urine is made in the kidneys and drains down the ureters into the bladder. When the bladder is full of urine it is emptied by muscular contraction from the bladder through the urethra. This process is called voiding or urination.
Vesicoureteral (VUR) reflux occurs when some of the urine backs up from the bladder into the ureters and sometimes into the kidneys. This can lead to a kidney infection and result in scarring of the kidney. Scarring can lead to hypertension later in life. Severe reflux can lead to kidney failure requiring dialysis or a kidney transplant. The Pediatric urology team aggressively manages reflux to prevent these possible complications.
VUR is diagnosed by history and through the use of a renal ultrasound and voiding cystourethrogram(VCUG) and other radiological tests. Through the use of these studies reflux is graded from 1to 5. Grade I is the mildest form of disease and Grade5 is the worst. Reflux is managed differently based upon what grade is diagnosed.
Frequently children with grade 1-3 reflux will simply "grow out" of their disease. Children with grade IV-Reflux are more likely to require surgery. No matter what grade reflux, all children are placed on prophylactic antibiotics. The purpose of the daily antibiotic is to reduce the chance of urinary tract infection (UTI) which can lead to kidney scarring. You will need to assess your child for signs of UTI. Some common symptoms are fever, burning with urination, frequent urination, incontinence, foul smelling or bloody urine. If your child develops any of these symptoms notify your pediatrician or the urology team. A urine culture will be obtained to diagnose an infection. Your child's antibiotic may be changed to treat the urinary tract infection. Occasionally children will develop breakthrough UTI's while on prophylactic antibiotics. If this is a common occurrence your child will be evaluated for surgical intervention. Surgery usually involves opening the bladder wall and reimplanting the ureter in the bladder wall. Some children may be able to be treated with a minimally invasive injection procedure.
To prevent a urinary tract infection it is important to keep in mind the basics of good urinary health. Encourage your child to empty his/her bladder frequently and to drink plenty of fluids to "flush his kidneys". It is also important to make sure your child does not become constipated. Dysfunctional bladder and bowel habits worsen symptoms of reflux. A diet high in fiber and water should help your child to move his bowels regularly. The urologist or nurse practitioner may prescribe a laxative if needed. Please administer all medications as directed. If refills are needed please contact one of the nurse practitioners who will assist you in this matter.