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What is a urinary reflux?

When urine from the bladder flows back up into the kidneys, this is called reflux. Urine normally goes only one way. When urine flows back up from the bladder to the kidneys, germs get into the kidneys. This can lead to infection in the urinary tract. If reflux isn't noticed, the repeated infections can lead to scarring of the kidneys. Reflux happens in about one-third of children who
have urinary tract infections (called UTIs for short)

Does a UTI mean there is something wrong with my child's urinary tract?

Most children who have a UTI have a normal urinary tract. Just as some children get ear infections even though their ears are normal, some children get UTIs even though they have a normal urinary tract. However, some children with UTIs may have something wrong with their urinary tract. Your doctor may order special tests to find out. This is more likely if your child is very young at the time of his or her first infection, or if he or she has repeated infections.

What kind of tests will the doctor perform?

There are several tests that look at the urinary tract. An ultrasound of the kidneys and bladder is a painless test that gives your doctor a good look at the kidneys and bladder.

A bladder x-ray, called a voiding cystourethrogram (VCUG), is a good way to look at the bladder. A small tube is put into your child's bladder. A liquid is passed through the tube into the bladder. This liquid shows up on x-ray. X-rays are then taken as the bladder fills and while your child urinates. This study gives good pictures of the bladder and urethra. It is used to see if your child has reflux.

Another test that is sometimes used in children with UTIs is a kidney scan. For this test, a small amount of radioactive medicine is put into your child's blood stream with an IV line. Pictures of the kidneys are then taken with a special camera. This is a very good test for finding scarring in the kidneys. It is most commonly used in children known to have reflux.

An intravenous pyelogram is another test that can be used to look at the kidneys and urinary tract. It is a lot like a kidney scan.

Which of these tests is ordered for your child depends on your child's age, gender, how many infections he or she has had, and how bad the infections were.

How is urinary reflux treated?

Reflux tends to go away on its own. So most children with reflux don't need treatment other than seeing their doctor regularly. However, some children with reflux need to take an anitbiotic every day to prevent UTIs. Some frequently used medicines are nitrofurantion (one brand name: Furadantin) and trimethoprim/sulfamethoxazole (some brand names: Bactrim, Septra).

Is surgery ever needed?

Most children with urinary reflux don't need surgery. A few children who continue to get UTIs while they are taking antibiotics, who develop new scarring of the kidney or have serious reflux, or who can't take antibiotics may need surgery. If your child needs surgery, your doctor will discuss the options with you.