Urology consult

We took Kaitlyn in for her urology consult on Monday with Dr. O.  Because of her age, and the grade of her VUR (vesicoureteral reflux) being III-IV, he feels strongly that her reflux will not go away on its own, and will most likely get worse.  The risk of not treating it is kidney scarring and permanent damage.  He put her on a low dose, prophylactic antibiotic, to prevent her from getting an infection in her kidney.  He wants her to get a scan done in nuclear medicine to check for extensive scarring.

His recommendation for treatment of the VUR, is to do Deflux.

Deflux is a gel that is injected around the ureteral opening.  It is a tissue bulking agent (kind of like a silicone material), that prevents urine from flowing back up the ureters.  The great thing about Deflux is that it is minimally invasive, can be done as an outpatient procedure, and has been proven to be very effective in children with VUR grades II-IV.  After the procedure, she is closely monitored for 6 months to a year, to see if the procedure was effective. If Deflux is not effective, she will have to have a complete ureteral reimplantation.  That surgery consists of changing the way the abnormally positioned ureter connects to the bladder, by creating a new tunnel into the bladder. 

(Normally, the ureter connects to the bladder, which is made out of muscle, in such a way that urine is allowed to enter the bladder, but not allowed to back up to the kidney. When the ureter enters the bladder abnormally, the valve formed by the ureter pressing against the bladder wall does not close properly, so urine refluxes from the bladder to the ureter and eventually to the kidney.) Clear as mud, I know.
Since we are moving soon, Dr. O thought we should get all of the scans and prep work done here, so that the new urologist will know exactly what is going on.  He feels that the person doing the follow up should be doing the procedures.  We are hoping and praying that the antibiotics that she is on will be effective enough that she won't have any more pyelonephritis until she can get the Deflux procedure.  We are also praying that we will find a really good pediatric urologist in North Dakota.