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My son had a cystography which showed that: Urinary bladder with smooth, even outlines. Grade 5 retrograde vesicoureteral outflow was visualized on the right side. Urethra normal. After voiding, the bladder is completely empty. The contrast medium still remains in the significantly dilated and distorted right cup-pyel-ureteral system. Conclusions: Grade 5 vesicoureteral reflux on the right side. Suspected vesicoureteral reflux on the left side. The urologist wrote the following opinion: The radiographs (CUM and USG) suggest a bilateral vesicoureteral outflow and a narrowing of the pyeloureteral junction on the right side (therefore the degree of the outflow cannot be assessed). Indications: antibacterial prophylaxis, dynamic kidney scintigraphy (on an outpatient basis). My son had a sequential kidney scintigraphy, from which we got the following description: Left kidney in the parenchymal phase quite evenly accumulates EC-Tc-99m. fm=3min. fw=5min20sec. Right kidney small, poorly accumulates EC-Tc-99m above this kidney, a slight spontaneous increase in radioactivity was recorded, while after voiding, an increase in radioactivity over the right kidney (features of urinary reflux) was recorded twice on the renographic curve. After administration of Furosemide i.v. over this kidney, there was a decrease in radioactivity of 24% within 10 minutes. The share of the left kidney in purification of blood from radiopharmaceuticals is approx. 95%, and the right kidney - approx. 5%. The examination shows a significant impairment of the function of the right kidney. We test the urine every two weeks and culture it once a month. The overall results for 2 months are fine. We are currently giving our son Furaginum 1/3 nighttime tablet. What else can we do? Do any additional research? What will happen next, what awaits us? Should the son be on a special diet with such a defect?
Vesicoureteral refluxes, regardless of their degree, are a symptom of dysfunction of the lower urinary tract, that is, of the bladder and urethra, where the main factor is the functional obstruction associated with increased urethral sphincter tension. It is just as dangerous as the inborn anatomical obstacle - the posterior urethral valves. Impaired bladder and urethral function, if diagnosed, should be adequately treated with pharmacological agents. The so-called is helpful in determining the type of disorderurodynamic examination.
Damaged kidney function - 5% contribution to cleansing - is not a sign of so-called reflux nephropathy and has nothing to do with drainage of the kidney. The fact that the kidney is small and secretes poorly indicates a defect of the "ureteral donut" from which the ureter develops already in utero. The misplaced ureteral donut, developing into the ureter, grows towards the tissue from which the kidney develops and ends up in the least valuable part of it due to its bad location. As a result, the kidney is small and dysplastic from birth. In your son, you should first of all try to stop the vesicoureteral outflow, and the kidney can not be removed, because it is not a kidney that will give rise to hypertension in the future. If the outflow survives and urinary tract infections are present, the kidney and ureter will have to be removed.
Remember that our expert's answer is informative and will not replace a visit to the doctor.
Lidia Skobejko-WłodarskaSpecialist in pediatric urology and surgery. She obtained the title of European specialist in pediatric urology - fellow of the European Academy for Pediatric Urology (FEAPU). For many years he has been dealing with the treatment of bladder and urethral dysfunction, especially neurogenic vesico-urethral dysfunction (neurogenic bladder) in children, adolescents and young adults, using for this purpose not only pharmacological and conservative but also surgical methods. She was the first in Poland to start large-scale urodynamic tests, allowing to determine the function of the bladder in children. He is the author of many works on bladder dysfunction and urinary incontinence.
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