*sigh* UTI, urologist needs education - Page 2

[shelbean91]

As far as VCUG, it was recommended to me to have one done for dd at 2 years. She had had 2 UTI's by then and I suspected a 3rd (turned out she didn't have one). So, she's had 2 UTI's total, she's now almost 6 and I refused the VCUG. Seemed pretty invasive to me, considering she was still wearing diapers at the time and sometimes we didn't catch her as soon as we should have (she wouldn't tell us she had peed and we only checked her every couple of hours).

I'm sure there are people who benefit from the test, but we took a 'wait and see' approach and that worked for us.

[jenP]

Update so far: after searching around I finally found a "foreskin friendly" pediatrician (thanks Carmen!) so I could get a trusted second opinion on the subject of abx and vcug. Our new ped is totally, totally anti-circ AND pretty up on the latest research, and he suggested a renal ultrasound instead of the much more invasive vcug. He did not recommend no testing at all because it IS so rare for a boy to get a uti that it makes you think you should take a look and make sure the kidneys are normal. See, common sense! Most other docs would say "oh, it's because of his foreskin." This guy said, "of course it has nothing to do with his foreskin. Let's see if there could be a kidney abnormality. If not, it could just be a random thing. Someone has to be the 1 in 1,000 boy that gets a uti."
So, we had the US but do not have the results yet.
I still haven't written to the urologist. Still planning on it.

Jen

[Sijae]

Originally Posted by Frankly Speaking

Jen, you did an admirable job with that guy! I wish I could always have that presence of mind. In all honesty, I think he is a two faced liar and he saw dollar marks all over your son's penis. It's only after you started reciting the facts to him that he started back peddling. It seems that he knows this but saw a chance to profit off of your son's flesh. That's disgusting!

I disagree with the VCUG after a single UTI at less than a year old and certainly disagree with prophylactic antibiotic regimines after a single infection. I know there are those out there that are advocating it but I just don't agree.
Frank

: I can't imagine doing an invasive test or such a horrifyingly long time on ABX after one infection! run run run run.... I wouldn't trust a thing that urologist tells you.

Laura

[Sijae]

Originally Posted by jenP

Update so far: after searching around I finally found a "foreskin friendly" pediatrician (thanks Carmen!) so I could get a trusted second opinion on the subject of abx and vcug. Our new ped is totally, totally anti-circ AND pretty up on the latest research, and he suggested a renal ultrasound instead of the much more invasive vcug. He did not recommend no testing at all because it IS so rare for a boy to get a uti that it makes you think you should take a look and make sure the kidneys are normal. See, common sense! Most other docs would say "oh, it's because of his foreskin." This guy said, "of course it has nothing to do with his foreskin. Let's see if there could be a kidney abnormality. If not, it could just be a random thing. Someone has to be the 1 in 1,000 boy that gets a uti."
So, we had the US but do not have the results yet.
I still haven't written to the urologist. Still planning on it.

Jen

That's good to hear Jen! Let us know how it goes.

Laura

[Revamp]

This is so awful, it is bad enough them spreading lies about the foreskin at birth but then doing so again when it comes to problems while completely (and highly imcompetantly) missing the real source is just downright atrocious.

Good on you! Educate him thoroughly, you could save dozens of foreskins that way.

[shaylahc]

Originally Posted by jenP

Update so far: after searching around I finally found a "foreskin friendly" pediatrician (thanks Carmen!) so I could get a trusted second opinion on the subject of abx and vcug. Our new ped is totally, totally anti-circ AND pretty up on the latest research, and he suggested a renal ultrasound instead of the much more invasive vcug. He did not recommend no testing at all because it IS so rare for a boy to get a uti that it makes you think you should take a look and make sure the kidneys are normal. See, common sense! Most other docs would say "oh, it's because of his foreskin." This guy said, "of course it has nothing to do with his foreskin. Let's see if there could be a kidney abnormality. If not, it could just be a random thing. Someone has to be the 1 in 1,000 boy that gets a uti."
So, we had the US but do not have the results yet.
I still haven't written to the urologist. Still planning on it.

Jen

A renal ultrasound will not show kidney reflux.

Kidney reflux is quite common, and no, you don't have to have a family history of it for your child to have it. It is true that UTIs are fairly uncommon in baby boys, but they ARE more common in intact boys under a year (that is a statistical fact). As to whether or not you should have the VCUG--that depends on how old your child is and how severe the infection was. My pediatrician told me that babies of either gender who present with a UTI have a 40-50% chance of having kidney reflux. It really is that common. And the problem with kidney reflux is that it can cause scarring of the kidneys which can ultimately lead to problems like high blood pressure or kidney failure later on in life. Your child doesn't even have to have an obvious UTI for this damage to happen--children can have chronic asymptomatic UTIs. I have known 2 people online whose DC had to have "dead" kidneys removed due to kidney reflux damage. It is certainly not something to take lightly.

It is up to you, the parent, to decide whether or not you want to proceed with the VCUG. But please do your research first and make an informed decision. I always worry when I see so many on this website giving out medical advice on subjects they don't know much about, under the assumption that modern medical care is evil and doctors are out to profit from the suffering of others. That just simply isn't true.

Here are some links about VUR or Kidney Reflux:

http://www.nlm.nih.gov/medlineplus/e...cle/000459.htm

http://www.mejfm.com/journal/Oct2004...rethrogram.htm

BTW on of my DDs had Kidney Reflux (surgically corrected) and I have an intact DS who was hospitalized with a UTI at 5 weeks (did not have reflux but did have hydronephrosis which resolved, and he never had another UTI). We have no family history of either condition.

[jenP]

Originally Posted by shaylahc

A renal ultrasound will not show kidney reflux.

My extremely knowledgeable and trustworthy pediatrician said that if a renal ultrasound showed swelling, we would then want to do a VCUG to determine for sure if/what grade reflux there was. He said if the US is completely normal there would be AT MOST a grade 1 reflux that would be outgrown before long. So no, a renal ultrasound will not specifically show kidney reflux. I never said it would. However, it is a valuable diagnostic tool with far fewer risks than a VCUG.

Originally Posted by shaylahc

Kidney reflux is quite common, and no, you don't have to have a family history of it for your child to have it.

I know.

Originally Posted by shaylahc

It is true that UTIs are fairly uncommon in baby boys, but they ARE more common in intact boys under a year (that is a statistical fact).

Of course, "there are lies, damn lies, and then there are statistics" (Mark Twain.) Sure, foreskins cause uti's in baby boys, as long as the baby boys are medically fragile preemies!

Originally Posted by shaylahc

It is certainly not something to take lightly.

And I am certainly not taking it lightly, thank you very much.

Originally Posted by shaylahc

But please do your research first and make an informed decision.

What makes you think I haven't?? Did you read my threads on my search for a trustworthy and knowledgeable physician? Do you know how much reading I've done at the medical library? Did you know my background is in the medical field and I've worked with and continue to have relationships with many doctors and researchers, including pediatricians? So don't go accusing me of denying my child medical care, because I am too lazy/stupid to research and/or because I am a luddite superstitiously reject anything a medical professional says.[/quote]

Originally Posted by shaylahc

I always worry when I see so many on this website giving out medical advice on subjects they don't know much about,

We simply share with others what we have learned from our experiences, no one here, even the doctors or nurses among us, purport to hand out "medical advice."

Originally Posted by shaylahc

under the assumption that modern medical care is evil and doctors are out to profit from the suffering of others. That just simply isn't true.

Actually, in some cases it is/ they are. Like the urologist who offered to perform a circumcision for my son IN PLACE OF testing to do an actual diagnosis. Quick easy money for him and no medical benefit, only risks, to my son. And we still would not have ANY information on the state of his kidneys!!! So yes, we do have to be skeptical of doctors, do our own research, and search high and low for trustworthy, knowledgeable doctors. It takes a lot of time and effort but that is my job description as a parent, to advocate for the BEST care for my children, NOT to take as gospel what the first doctor we see says.

Originally Posted by shaylahc

Here are some links about VUR or Kidney Reflux:

http://www.nlm.nih.gov/medlineplus/e...cle/000459.htm

http://www.mejfm.com/journal/Oct2004...rethrogram.htm

thanks, but I already read those. and more.

Originally Posted by shaylahc

BTW on of my DDs had Kidney Reflux (surgically corrected) and I have an intact DS who was hospitalized with a UTI at 5 weeks (did not have reflux but did have hydronephrosis which resolved, and he never had another UTI). We have no family history of either condition.

Glad they are all doing well!

Jen

[J-Max]

Originally Posted by jenP

He said if the US is completely normal there would be AT MOST a grade 1 reflux

I just had to comment on this. This IS NOT TRUE. I am very knowledgable about renal reflux - I had it and have 2 girls with it. My oldest had a completely normal u/s and had grade 4 and 5 bilateral reflux. U/s can only detect structural abnormalities - which can result in renal reflux, but the reflux can also occur with no structural defects. We have had a ton of posts on this subject, I will go find links to them!

Here are 2 posts that contain a lot of info on UTIs and reflux
another intact boy with uti issues

A thread about renal reflux


HTH

[hummingbear]

A story to add............

He got an abx resistent UTI and had to go into the hospital to be put on a 10 day IV with strong abx. He had reflux (low grade). It was recommended that her son go on abx to prevent another UTI. After being plagued with thrush for months, she found out that there is no conclusive evidence that abx taken as a preventative to UTIs actually does anything. She was mad. Her doctor was not opposed to taking her DS off abx. She started to EC with her son (diapers push poop where it isn't supposed to be). No further UTIs. Her son was watched for a few years to see if the reflux would resolve or worsen. At three, they chose surgery to clear an obstruction.

At first it was recommended that she have her son circ'd too. She refused. Then a doctor said that the foreskin had nothing to do with his UTI. It does seem to me that a great many urologists are still clinging circumcision as a solution. I wonder where studies will guide them in the next decade?

Good Luck

And to you for doing so much research.

[jenP]

Originally Posted by Jessmcg

I just had to comment on this. This IS NOT TRUE. I am very knowledgable about renal reflux - I had it and have 2 girls with it. My oldest had a completely normal u/s and had grade 4 and 5 bilateral reflux. U/s can only detect structural abnormalities - which can result in renal reflux, but the reflux can also occur with no structural defects. We have had a ton of posts on this subject, I will go find links to them!

Well, a colleague of my pediatrician's is on the cutting edge of research in this and he said that US does not only detect structural abnormalities. What he would be looking for would be swelling. If he had reflux that was causing urine backup in the kidneys to the point of being a risk to the health of the kidneys, then he would see signs of it on the US. Yes, there could be reflux in the absence of signs on the US, but if it isn't causing problems that he could see then he doesn't think it would be causing problems that would risk the health of the kidney.
Since DS's US is completely normal, we are closely monitoring him for any signs of fever/malaise/difficulty or pain on urinating, and doing a clean catch "bag" even in the absence of symptoms every three months. After looking into this for 3 months and consulting with a number of physicians, and after having the US, I feel very comfortable with this as a prudent course of action. And I'm not avoiding the VCUG because I don't like to cause discomfort to my child. If I thought it was really neccessary I would go ahead and let him be unhappy for the ten-minute test. I am avoiding this test because I believe the risks (of hospital-acquired infection from having an invasive test, of complications from any accidental scratching with the catheter and any reactions to the dye, plus the exposure to x-rays) AT THIS POINT outweigh any benefit to the test. As the situation and symptoms may change, at a later time it may be that the benefits would outweigh the risk. But for now, even if we had done the test and seen some reflux I believe we would be doing exactly the same followup as described above.

There are pros and cons to every medical decision (tests, vaxes, medications, surgeries, etc.) and we all have to carefully weigh the risks vs. benefits, not only using published studies but also in relation to our own child and their overall health and situation. So you may have done tests for your children that I don't find appropriate for my child at this time. That does not mean EITHER of us made the "wrong" decision. It is obvious we have all looked into this extensively and weighed many factors into our decisions.
I think we ALL here at TCAC can agree however that circumcision is unlike any of the medical decisions we will look into as parents. The vcug may have risks and benefits, antibiotic therapy may have risks and benefits, vaccines may have risks and benefits, and on these topics different parents will have different right answers for their children. We need to continue to get the word out that circumcision, unlike vaxes or corrective surgeries or tests or medications, has NO MEDICAL BENEFITS, ONLY RISKS. It does NOT treat, prevent, or cure anything any more than removing any other normally functioning body part does, and any doctor who suggests circ as a treatment for uti's, especially as a substitute for further testing, is to be distrusted.

Jen
Jen

[Revamp]

Well said Jen...

[J-Max]

I just want to comment that I was not saying you were not doing what you think is best for your child. What I posted was my understanding from our ped urologist and dealing with this issue for many years. If your babe is not having problems, then clean catch testing and watching for signs of problems is more than enough - that is what we are doing with our 2 year old. Many children with renal reflux outgrow it by age 5.

I completely agree with you when you said "We need to continue to get the word out that circumcision, unlike vaxes or corrective surgeries or tests or medications, has NO MEDICAL BENEFITS, ONLY RISKS. It does NOT treat, prevent, or cure anything any more than removing any other normally functioning body part does, and any doctor who suggests circ as a treatment for uti's, especially as a substitute for further testing, is to be distrusted."

I only have girls, but if I ever have a boy they will not be circed, and I have talked 2 friends out of doing it to their boys.

I am sorry you felt attacked, that was not my purpose

[jenP]

Originally Posted by Jessmcg

I am sorry you felt attacked, that was not my purpose

Thanks! Sorry for being so sensitive. Actually, it was not your post so much but an earlier one that I felt was attacking my choice and the reasons for it. I apologize for taking it out on you.

Hope you and your girls are doing well! At one time in my life I had recurrent uti's too, but they stopped when I stopped sleeping around so much. Maybe if all those guys weren't circ and didn't have to pound, pound, pound away then bacteria wouldn't have gone up my urethra so much. See, another reason to not circ!

Jen

[Revamp]

Originally Posted by jenP

At one time in my life I had recurrent uti's too, but they stopped when I stopped sleeping around so much. Maybe if all those guys weren't circ and didn't have to pound, pound, pound away then bacteria wouldn't have gone up my urethra so much. See, another reason to not circ!

I am adding that to my long list of "If all else fails Shock Tactics"...