What is Ureteral Reflux?
The urinary system is comprised of the kidneys, ureters, bladder and urethra. Normally, urine is formed in the kidneys and drains down the ureters to the bladder. When the bladder is full of urine it is emptied by muscular contraction from the bladder and through the urethra. This process is called voiding or urination. Vesicoureteral reflux occurs when urine backs up from the bladder into the ureters and sometimes into the kidneys. This can lead to a kidney infection and scarring of the kidney. Scarring can lead to hypertension and possible kidney failure later in life.
What Can I Expect from Surgery?
The operation usually requires a two night stay in the hospital afterwards to recover. Your child will come to the hospital the day of surgery and go home 1-3 days after. No lab work required before surgery unless specifically mentioned by the surgeon.
Plan on taking off approximately 5-7 days including the day of sugery. This will allow you to be present with your child while they recover in the hospital and at home.
Bring for your child:
Bring for Yourself:
It is best, when possible, to make arrangements for siblings to stay at home on the day of surgery, in order for you to participate fully in your child's care.
Care of the Incision:
Your child will have a small lower abdominal incision covered with a plastic "Tegaderm" dressing. This will remain in place for 5 days after surgery. The sutures are all absorbable.
Intially your child will have a catheter in her bladder called a "foley". This will drain the urine from your child's bladder. The urine will be bloody looking right after the operation but will slowly clear up over the following 1-3 weeks after sugery. The foley catheter will remain in place for 1-3 days after sugery and is easily removed by the nurse.
A suprapubic tube or bladder catheter may be in place after surgery. This is a rubber tube that will drain urine from your son's bladder. The tube will exit from the bladder to the outside of the lower abdomen. It is held in place with sutures and is easily removed 5-7 days after sugery. This is usually done in the office by the surgeon or nurse practitioner. The urine will initially be very bloody and will clear up over the next 1-3 weeks. Your son will void through his urethra normally once the tube is removed.
Your child's pain will be managed by the Pain Management team at the University of Maryland. Frequently children will have an epidural catheter in place for pain management after surgery. This will keep your child comfortable and still allow them to move around and get out of bed. The catheter is well secured with tape tp prevent dislodgement. Once your child is able to tolerate a regular diet, the catheter will be removed and oral pain medications will be be started. Initially children are given a clear liquid diet and advanced to a regular diet as tolerated. Some children may experience nausea or a decreased appetite after surgery. An IV will be in place to ensure that your child receives adequate hydration. It is important for you to encourage your child to drink lots of liquids after the surgery. This will ensure good urine output and will keep the foley or suprapublic tube from "clogging". The bloody urine will clear up more quickly with good oral intake.
You are encouraged to stay with your child 24 hours a day while on the Pediatric Unit. There are cots available in each room for one parent to sleep over. Your active participation in your child's recovery is encouraged and appreciated.
Post Operative Discharge Instructions:
Continue to give your child the prophylactic antibiotic he/she was on before the surgery. This will be necessary for several weeks after surgery until a follow up ultrasound and VCUG is done at 6 weeks. Sometimes children will experience pain with urination at home. This is frequently due to bladder spasms. Your child should be encouraged to drink plenty of fluids. Give your child prescribed pain medication the surgeon ordered. Sometimes Ditropan will help with bladder spasms after surgery. Administer this as prescribed. Frequently, children will void more comfortably if sitting in a warm bath. If these measures do not bring relief please call the office. Your child may attempt to avoid drinking to avoid urination. Please be aware of this.