Childhood urinary tract infections are not uncommon, affecting about 3 percent of all children every year. Usually these can be treated with antibiotics and are not cause for grave concern.
However, a urinary tract infection also can be a sign of a more serious problem called vesicoureteral reflux, or VUR, which affects about one in every 100 children.
VUR is an irregularity in the urinary tract that allows urine to flow backward, from the bladder to the kidneys. Reflux of infected urine can lead to kidney infection and scarring, and can cause long-term kidney damage.
There are two types of VUR. Primary VUR is present at birth, caused by a defect in the valve system at the end of the ureter, the tube that carries urine from the kidneys to the bladder. This is the most common type and is usually detected shortly after birth.
Secondary VUR occurs when an obstruction in the bladder or urethra causes urine to flow backward into the kidneys. Secondary VUR can occur at any age and can be caused by surgery, injury or abnormal bladder- emptying patterns.
About one-third of children diagnosed with a urinary tract infection have VUR. Symptoms of UTI include fever, pain or burning with urination, frequent urination and the feeling that the bladder does not empty completely. Fever is often the only symptom in a small child.
VUR is usually diagnosed when a UTI is suspected. Following an evaluation of the history of your child's symptoms and a physical exam, additional tests might be recommended.
Ultrasound uses sound waves to find out the size and shape of the kidneys. It can't detect reflux but indirectly can identify it in case of excess urine held in the kidney. A voiding cystourethrogram, or VCUG, can detect reflux and find out whether it's mild or severe. The bladder is filled with dye, and pictures are taken of the bladder as it fills and empties.
Treatment options include medical management and surgery. Medical management involves long-term antibiotic treatment to prevent the occurrence of urinary tract infection while waiting for the reflux to go away on its own. This avoids the risks of surgery, but long-term use of antibiotics has its disadvantages, such as antibiotic resistance.
Endoscopic treatment involves the injection of material in or around the area where the ureter enters the bladder to repair the valve function. This prevents reflux of urine toward the kidneys. This procedure is minimally invasive and does not require any incisions. It is usually carried out as an outpatient surgery, with the patient under general anesthetic. Endoscopic treatment of VUR offers a success rate of about 80 percent, with a relatively small risk of complications.
For severe cases, reimplant surgery might be needed. This is a major procedure that involves surgically fixing the ureters to stop VUR. Success rates are as high as 95 percent, but the procedure is more invasive and might require a one- or two-night hospital stay.
Before decisions are made about treatment, parents should consult with a qualified surgeon to rule out any other possible underlying conditions. Patients with more complicated urinary anomalies might require different surgical options.