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Wednesday, May 22, 2013
Urinary and Genital Disorders (Children)
Use of Deflux with abnormal bladder
My son was diagnosed with VUR at 4 months after a kidney infection. At that time, it was a grade 1-2. Since then, it has gone up to a grade four at a year and a half, gone down to a 2-3 on it`s own at 4 years old, then down to 1-2 on one side and 2-3 on the other with 6 months catheterization because urologist thought he had a high pressure, low capacity neurogenic bladder. We stopped catheterizing because the doctor no longer felt his bladder was neurogenic, and just small and abnormal, and a year later, at five years old, the reflux is back up to 3 on both sides with bladder spams that he feels the reflux is contributing to. Recommendation is to do reimplantation surgery because of small bladder capacity and spasms. My question is, should we go ahead with the surgery, or do deflux?
This is a difficult question to answer. Reflux increases the risk of kidney infections. Boys tend to be less susceptible to UTIs than girls. Why does the urologist think that your son is having "bladder spasms"? Is he having urinary incontinence during the day? Is he having UTIs? If there are no UTIs and his bladder control is fairly normal, then he may not need treatment. If he is experiencing incontinence during the day with frequency and urgency, he is at increased risk of kidney infection because of the reflux, but correcting the reflux, either with Deflux or open surgery, probably will not correct the bladder spasms. More information is necessary to provide an educated answer.
Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University