Not a wee problem

As some of you know by now, my girl came down with UTI.

What I had expected to be a routine followup turned into one of mother's nightmare.

Why? When the first PD called and explain that it could be due to reflux and a MCUG test will probably be ordered, I got super confused - I had assume reflux = reflux after feeding, and I couldn't see the connection.

Then during the followup appointment, my PD (who was on leave last week) explained that some 30% of babies who have UTI before their first birthday are likely to be having vesicoureteric reflux.

What is vesicoureteric reflux?

Vesicoureteral reflux (VUR) is the condition in which urine travels backward from the bladder toward the kidney and may affect one or both ureters.

In most children, reflux is a birth defect and is caused by an abnormal attachment between the ureter and bladder with a short, ineffective flap valve. In some children, an infrequent urination pattern may cause reflux to occur.

When the "flap valve" malfunctions and allows urine to flow backward, bacteria from the bladder easily enters the kidney. A child with reflux is more likely to develop a kidney infection (pyelonephritis) that can cause kidney damage. More severe reflux is associated with greater kidney damage. When urine backflow is more severe, the ureters and kidneys become large and distorted. Although reflux can have these serious medical consequences, it is a "silent" abnormality, that is, reflux does not cause pain, discomfort or problems with urination.

Please refer to here for more information.

There are 5 grades to this - Grade 1 to 3 are usually not so serious, and can be treated with a long term daily dosage of anit-biotics for a few years, before the valves mature on their own. For Grade 4 & 5, it usually means a surgery to repair the valves are required.

The horror story was related by my PD, who told us why he would recommend us to do the MCUG test to rule out the above, or if present, to "fix" it.

He had to attend to an emergency case in which this boy almost drowned and they managed to save him. However, they noted his recovery was somewhat slow and he wasn't responding as well as they had expected. His blood pressure was a shocking 180+ over 100+ and they concluded he had a stroke. A brain scan revealed that it was so and they had to check for the cause of the high blood pressure. They subsequently found that the boy had 1 damage kidney and the other kidney was beyond repair.

He had grade 5 vesicoureteric reflux and it wasn't detected - he had frequent UTIs and the parents just bought anti-biotics off the black market and self-medicate. As a result, their boy almost died and today half of his body is still paralysed.

Scary? You betcha.

So what's this MCUG test? (Source is here)

Micturating Cystourethrogram (MCUG)
or 'Wee Wee Test'

This test is done to give us information about your bladder. This is the bag inside the body where urine from the kidneys is stored until it is emptied out when you go to the toilet.

The test involves passing a small tube into the bladder. The x-ray contrast, which is used to take pictures of the bladder, is run in through this tube.

After the x-ray nurse/doctor has washed between your legs/ s/he will insert a small tube, called a catheter, into the bladder. A local anaesthetic jelly is used to lubricate the catheter, which is held in place with a piece of sticky tape.

The doctor or radiographer will run warm x-ray contrast through the tube and into the bladder. After a short while when the bladder is full your child will pass urine around the tube and the tube will slide out. X-ray pictures are taken while the bladder fills up and during emptying.


Parent Points
The test takes about 30 minutes. Your child will be given a warm liquid, (X-ray contrast) via a tube into the bladder. This is done to show the bladder and urethra (its outlet tube), and to see if urine goes backwards from the bladder (reflux), or if there is a blockage.

I just feel so uncomfortable about the test - I probably need more time to recover from the "trauma" than my girl. Anyway we need to let the PD know if we want the test in 5 weeks time. I'll prob take a few days off just to make sure she is OK. *sigh*