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Urinary and Genital Disorders (Children)

Ureters Reimplatation Surgery

01/07/2009

Question:

My daugther is 6 years old. She has had reflux since she was 4. She started out as a Grade 4 then went down to a Grade 3 the last two years. It has not changed since her last VGCU. She has had one UTI back in March `08 and then in November she showed signs of a bladder infection but the culter showed nothing. In December she was also having problems but once again the culutre showed that she did not have an infection. Well her doctor wants her to have the Ureter Reimplatation surgery soon. He said that she will not grow out of it and will benefit from the surgery. I do know if she gets off the antibotic she will get an infection. I just don`t know if she should have that done or not. I was just surprised that they wanted to do the surgery so soon. Does it sound like it might be too soon, that I should wait a little longer?

Thanks

Answer:

That is a difficult question. There are many factors that enter into a decision for surgery. Girls are more likely than boys to have a UTI, so the majority of children who undergo surgery for reflux are girls. The purpose of surgery is to prevent kidney infections and kidney scarring. If she is getting kidney infections, that is a pretty good indication for surgery. However, it sounds like she had a bladder infection. Also, it is important to be certain that her bladder function is normal, in other words, is not experiencing daytime wetting, frequent urination, or sudden urge to urinate.

There is a possibility that the reflux will disappear, even if it is grade III. It is most likely to disappear over time if the reflux occurs only when the bladder is full or during voiding. On the other hand, if reflux occurs when the bladder is filling, then it probably will not resolve, given that she is 6 years old. These are some of the factors that we consider when deciding whether to recommend surgery.

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Response by:

Jack S Elder, MD, FACS, FAAP Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University