Thank you for your query at DoctorSpring.com
I can understand your situation. This is a challenging condition for the child as well as the family. Your child seems to have advanced bladder outlet obstruction with vesico ureteric reflux and chronic kidney disease.
There are a number of concerns regarding the current condition:
1. Recurrent urinary tract infections - These occur due to the stasis of urine inside the dilated portions of the urinary tract. This can be prevented by
a. antibiotic prophylaxis- usually with CO-TRIMOXAZOLE (SEPTRAN) daily to prevent UTIs
b. good genital hygiene practices such as wiping from front to back and never in the opposite direction, keeping the region dry and airy, avoiding continuous contact of wet, soiled diaper with genitalia (checking diapers infrequently, etc)
c. drinking plenty of fluids and preventing dehydration
d. Pharmacological measures such as urine alkalinizing agents may be tried but they are not of proven benefit.
e. Surgical options such as ureteric diversion procedures or percutaneous ureterostomy.
This situation is similar to a blocked drainage duct at home. Initially it would cause overflowing of foul contents in the bathroom. As the condition progresses, one would not be able to step into the house. Here, the bladder outlet seems to be blocked because of a spastic sphincter.. So the urine accumulates and dilates the urinary tract (ureter). As the back pressure worsens, kidneys are also afffected and they get thinned out. This condition is called HYDRO (abnormal urine accumulation in) -URETERO (ureter and)- NEPHROSIS (kidneys) [HDUN]
The problem is that once a child goes into established gross HDUN, there are very few options left. None of the options can reverse the condition completely as the kidneys are destroyed (thinned out). Over the years, child develops RENAL DYSFUNCTION --> KIDNEY FAILURE and becomes dialysis dependent.
Surgical options (urinary diversion procedures) may be considered on a case to case basis after assessment of baseline kidney functions. The tests that are recommended include DMSA scan to assess scarring and DTPA scan to assess function of kidneys. if there is residual function, then the procedures can be attempted after appropriate urodynamic studies on a case-to-case basis.
Please get DMSA/DTPA/ EC scans and get in touch with a pediatric surgeon.
Dr. Saptharishi L G