Any doc’s out there? VCUG question - Mothering Forums

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#1 of 11 Old 04-15-2009, 05:47 PM - Thread Starter
 
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My ds recently had a uti (along with an ear infection and RSV). His pedi wants him to get a vcug. I’m really, really, really on the fence about this. I don’t want to put him through something so invasive unless its necessary. Fwiw, my ds isn’t circ’d and it was his first uti. Could I get away with waiting to see if it happens again? I’m wondering if his urine culture was contaminated.

Thanks!
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#2 of 11 Old 04-15-2009, 05:52 PM
 
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Im not a Dr......But dd has had 3 VCUGs done. But only because she had repeated UTIs and I have a history of kidney reflux...and family history of kidney disease.

I dont know if i would put my dd through that again ever, especially since its his first, and there is no family history?

What where the circumstances of his UTI? I would get an opinion from a urologist asap, a pedi shouldnt be ordering such invasive tests without first sending you to a urologist IMO.

How old is your LO?

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#3 of 11 Old 04-15-2009, 08:37 PM
 
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Not a professional but the mom of a 4yo intact son who has had a UTI (took four rounds of antibiotics and three docs to clear it up).

Our son didn't get his first UTI until he was 4 so we did not want to put him through a VCUG right away. He had an ultrasound that came back fine. The urologist told us at his age if he had reflux the ultrasound would more than likely have shown something.

If my son had gotten his first UTI when he was an infant I would probably have take a wait and see approach. I would want to clear up the first infection and then if he had another one I might explore more testing but through an intact friendly urologist.

I hope your little guy starts feeling better soon.
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#4 of 11 Old 04-16-2009, 04:55 AM
 
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Was also wondering how old your LO is. Also, did they do a cath for the urine culture, and did your ds have any fever or nausea along with the UTI?

Not a doctor, but my daughter has bilateral kidney reflux and she has had 2 VCUG's. She had her first at 6 wks old and her second at 10 months (she'll have her 3rd in Nov). Obviously, I'm a little biased, but I would be inclined to have the test done in an infant/toddler under the age of 3, especially if it was accompanied by fever/nausea. If it is the first UTI in an older child, I might be more inclined to wait. It's hard to put your kids through difficult tests, but kidney infections can be very dangerous in young children.

As for the circumcision issue, if you decide to do the test, I recomend a children's hospital, and make sure you've talked to your doctor and that they have someone experienced doing the cath in uncirc'ed boys.

Hope he's feeling better!
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#5 of 11 Old 04-16-2009, 09:33 AM - Thread Starter
 
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Thank you for all of the advice, everyone. This is such a difficult decision to make, ya know?

My son is 3 months old. He did have a fever with the UTI but he also had RSV and an ear infection at the same time so I'm not sure what to make of it. He was cathed for the urine sample. He recently had another urine test (no cath this time) at his follow up pedi appt. and it came back negative. He had an ultrasound while he was in the hospital and it was fine. Nothing suspicious or out of the ordinary.

I had called the urologist to find out if the procedure was really neccessary but I was only able to speak with a nurse. She said it was standard procedure. I'm going to call back again to see if I can get ahold of an actual urologist, this time.
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#6 of 11 Old 04-16-2009, 01:18 PM
 
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I hope you can speak with the urologist soon. I know this is probably not what you want to hear (sorry) but honestly for a UTI in a 3 month old, I would do the test. I agree that your case is a little more complicated b/c of the ear infection and RSV (poor baby!!!) so I can see why you are hesitant. Since they cath'ed the test was probably pretty acurate. A VCUG is not a fun test (at all) but it is done without sedation, and it only takes about 30 minutes. I have actually found that it was much easier to do when dd was little. She doesn't have any memory of it so it wasn't traumatic (at least not for her - maybe a little for me).

An ultrasound is a good tool for seeing some problems, but it cannot diagnose reflux, and is fairly inaccurate in seeing a lot of the problems that can be found in the urinary tract. It will show any major scarring in the kidneys, but can miss small scarring or abnormalities like duplicated ureters, etc.

If you decide not to do the test, just make sure you know all the signs of a UTI in an infant. There is a greater chance of damage to the kidneys with a UTI under the age of 1 year, and the faster you get treatment, the better chance of preserving the kidneys. For us the signs were generally poor eating with a high fever or foul smelling urine.

Good luck with your decision.
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#7 of 11 Old 04-16-2009, 01:29 PM
 
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I would honestly what to know the stats on how many boys with only 1 UTI have kidney reflux. It seems like a trend these days to overuse VCUG.

Since your LO's immune system was already compromised fighting off RSV, etc, then I would be less inclined to do the VCUG for only one UTI. I would definitely get a 2nd opinion before doing VCUG.

I agree with the PP who suggested being very careful about the personnel who will cath your LO. My DH is always trying to educate nurses about the proper way to cath intact boys. Even ped nurses frequently pull back the foreskin at least partially.
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#8 of 11 Old 04-16-2009, 03:54 PM
 
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Have you been to a Pediatric Urologist?? It might be worth a drive to a bigger city if you don't have one near you. Generally they don't over react, are used to the sensitivities of kids/babies... I wouldn't do anything until you get a second opinion from (another?) urologist. I certainly wouldn't do this on the advice of a pediatrician only.

I am not a professional, just a mom whose intact son also had urinary problems. But NOT related to being intact.
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#9 of 11 Old 04-16-2009, 05:07 PM
 
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Check out these previous threads about VCUG.
http://www.mothering.com/discussions...&highlight=uti
http://www.mothering.com/discussions...&highlight=uti
http://www.mothering.com/discussions...&highlight=uti
http://www.mothering.com/discussions...i#post12414052

Personally, unless I would *do* something differently due to the potential results of a diagnostic test, I wouldn't put myself or child through it. An ultrasound could indicate some antatomical concerns. But, with one UTI, I wouldn't start with a VCUG. I would rather do a monthly Urine for culture and sensitivity, to assure no UTI. And probiotics prophylactically. "probiotics prophylaxis was as effective as antibiotic prophylaxis in children with persistent primary VUR. " http://www.springerlink.com/content/1741p5k22284x265/

I am concerned that a breastfed baby has had so many infections, so young. The issue is that multiple infections could be a symptom that your baby's immune system is impaired. Why? Unfortunately, steroids and antibiotics further suppress the immune system. I'd be concerned about gut healing for both of you as many immune system issues are due to dietary allergies and undigested proteins from mama's milk. There are many alternatives to improve the immune function. I imagine there is some underlying allergy issue, either environmental or dietary.

Most commonly, dairy is associated with ear infections and excess mucus production. Does baby have any eczema, green mucusy stools, red ring around anus, rash, reflux, restless sleep "normally"?

I always prefer whole food probiotics. Not sure which probiotics you all are using, if any. But, none of the bottled probiotics have the same ability to withstand the stomach acid and remain viable into the large intestine as non-dairy kefir, fermented vegetables. Those are quite easy, if you need more info.

Probiotics can prevent UTIs. So can homeopathy.


Specific research studies are linked in the threads.

Probiotics. http://www.springerlink.com/content/1741p5k22284x265/

Homeopathics: http://www.truestarhealth.com/Notes/2262002.html



I would eliminate dairy from your diet. Dairy is the most common source of dietary allergen and mucus production. Here is a list of hidden diary: http://www.kellymom.com/store/handou...dden-dairy.pdf

I recommend vitamins and minerals come from whole foods. But, have you been following the digestion, absorption, detox pathways discussions to gut healing and allergy resolution? Basically, if we digest the proteins, they don't leak and thus we have fewer toxins to detox. Proper stomach acid (HCl) and specific nutrients are required for detox. You can read more about all of this here: http://www.mothering.com/discussions...e#post13406780


This is a copy of a recent post of mine regarding ear infections and the association with dairy intolerance. http://www.mothering.com/discussions...n#post13412976 "In one study an astonishing 86% of the children tested became free of ear problems once they came off dairy food."
http://www.safekids.co.uk/EarProblemsAndAllergies.html
http://www.healthychild.com/ear-infe...ternatives.htm
http://www.vitacost.com/science/conc...infection.html
http://www.femail.com.au/ear-infections-truestar.htm



HTH, Pat

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#10 of 11 Old 04-16-2009, 05:46 PM
 
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Here is what Dr. Sears says:
http://www.askdrsears.com/html/8/t080800.asp

"Except for the ultrasound, none of these tests sounds very fun, especially when it's YOUR child. Deciding when testing should be done is difficult. You need to weigh the likelihood that an abnormality is there and how serious such abnormalities can be versus the trouble and trauma of putting your child through such testing. Here is the standard medical recommendation that most doctors may follow. Children should have an ultrasound and VCUG in these instances:

Newborns who have a single bladder infection
Infants less than one year of age who have a second bladder infection
Older children who have had more than three or four infections
Your doctor may choose to be more or less aggressive than these guidelines. There is really no "right way" to decide."

I guess at 3 months old your DS qualifies as an infant so I would wait for a second UTI before even considering such an invasive test. If you decide not to do the test I'd be really carefully watching him to catch the next UTI asap. The UTI's are what is dangerous to kids with VUR and that is why they are treated with long term/low dose abx to prevent infections. You may even choose to do at home urine tests. And also as PP said I would consider if there is any family history of VUR, because that maybe inclination of possibility of you DS having this.
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#11 of 11 Old 04-16-2009, 06:45 PM
 
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Quote:
Originally Posted by FernG View Post
I would honestly what to know the stats on how many boys with only 1 UTI have kidney reflux. It seems like a trend these days to overuse VCUG.
Just thought I would throw out this link in case it was useful. It talks about imaging for boys under the age of 8 wks with UTI. I know your LO is a little older than that, but it is an interesting article with some statistics to boot. Boys are actually more prone to having urinary issues before the age of 1 than girls are. After the age of 1 that changes quite dramatically.

Too be honest, I'm not sure that getting a second opinion from another urologist (assuming you're seeing one already) will be different, simply b/c the AAP recommends doing the VCUG so most if not all urologists would recommend it, even if it was just as a CYA. We spoke to 3 different uros and all recommended it for us.

Pat also makes a very good point. If you are not willing to treat the VUR with prophylactic antibiotics, then it may not be worth doing the test unless there are other UTI's, or other urinary issues.
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