Renal scan (nuclear scan)
Radioactive material is injected into a child's vein and followed through the urinary tract. The material can show the shape of the kidneys, how well the kidneys function, if there is damaged kidney tissue, and the course of the urine. There is a small amount of radiation received in the study. The radioactive material leaves the body in the urine.
Voiding cystourethrogram (VCUG or cystogram)
A catheter (a hollow, soft tube) is used to inject an opaque dye into the bladder. This X-ray test can diagnose VUR and identify problems with the bladder or urethra.
Cystoscopy
A cystoscope uses lenses and a light source within a tube inserted through the urethra to directly view the inside of the bladder. It's used when other tests or symptoms indicate a possible bladder abnormality.
Intravenous pyelogram
Opaque dye is injected into a child's vein and then X-rays are taken to follow the course of the dye through the urinary system. Although this test is still used sometimes, the renal ultrasound and renal scan have replaced the intravenous pyelogram in most cases.
Because VUR can lead to kidney infection (pyelonephritis) and subsequent kidney damage, children with the condition must be monitored closely. Usually, surgery isn't necessary because many children will outgrow the condition. Even for kids who don't outgrow it, surgery may be unnecessary because antibiotics are often successful in warding off UTIs.
The most common type of surgery to correct VUR is ureteral reimplantation, in which one or both ureters are reattached to the bladder to decrease backflow of urine from the bladder to the ureters and kidneys. Although the success of ureteral reimplantation is greater than 90%, only those who have recurrent UTIs while on antibiotic prophylaxis (preventive therapy) will be considered for surgery.
Blockages can interfere with normal urine flow, which serves to wash bacteria out of the urinary tract. Because severe blockages in the ureter or the urethra may ultimately lead to repeated kidney infections and kidney damage, they may require surgical intervention. Kidney stones are another source of blockage that may obstruct the path of urine.
When anatomical defects have been ruled out, antibiotics may be prescribed for months or even years to prevent recurrent infections.
The Future for Managing Recurrent UTIs
Doctors have started to use a less invasive way to correct VUR than implantation. The procedure involves the injection of such materials as Teflon, Delflux, or collagen through a cystoscope. This procedure was considered experimental a few years ago, but is rapidly gaining wider acceptance.
Recent studies have found that women and children who get recurrent UTIs may lack certain immunoglobins (a group of proteins that fight infections). Some researchers are optimistic that a vaccine may be developed that could help boost a person's production of antibodies that fight UTIs. The most promising vaccine would protect against E. coli (the most common bacterium that causes UTIs), but it's still in the experimental stage.
Home Treatment
Here are some additional things to consider to help prevent recurrent UTIs in your child:
Diet Modifications
Encourage your child to drink 8 to 10 glasses of water and other fluids per day. Cranberry juice is often suggested because it may prevent E. coli from attaching to the walls of the bladder. Always ask your child's doctor, though, if your child should drink cranberry juice because it can interfere with some Larissa Hirsch, MD
Date reviewed: November 2006