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Urinary and Genital Disorders (Children)

1 yr Later Another Positive VCUG

06/15/2009

Question:

My daughter will be 3y/o next month. Last year when she was 18 months she had a bad UTI which got her put in the hospital for 3 days. A few wks after she went and had a VCUG done. It came back with reflux on both sides. The right side was a little worse of the sides. She was put on Bactrim for the last yr. We had the procedure done again today. They said the L side this time only refluxed when the bladder emptied not when it got full. Also that the R side was still worse of the 2 sides. I believe she said it was mild to moderate on the R side. Im curious as to what options there are now?

Answer:

It depends in part on whether she is toilet trained. However, the 4 options would be:

1) Stop antibiotic prophylaxis if she is toilet trained and perform antireflux surgery if she develops another UTI with fever

2) Continue antibiotic prophylaxis and repeat a VCUG in 1 year

3) Perform Deflux injection therapy

4) Perform open antireflux surgery

There are advantages and disadvantages to each approach. Options 3 and 4 are intended to minimize the risk of developing a kidney infection and allow her to stop antibiotic prophylaxis.

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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