Cystoscopy or MCUG or both? And how to prepare?

[MariaBN6]

Hello all, I am quite new here, have been more of a reader but now want to ask for advice. My daugher (3.5 y.o) has been diagnosed with duplex kidney. We had the DMSA scan (where they inject a dye into vein and then take x ray 3 hours later) which did not confirm scarring on kidney. However, doctor insists on further investigation - cystoscopy with MCUG to find out how duplex kidney looks and if there is reflux. This is done under general anasthetic. Had a second opinion from a urologist who said you can get away with just MCUG done (catheter into urethra and then filling up the bladder and then x ray) to check for reflux and if there is no reflux you are fine. Has anyone had an experience similar to ours? I am more inclined to have just the MCUG done as don't want her to go thru general anasthetic. If then smth corrective needs to be done she'll have to go under it again... But with MCUG am also quite terrified how is she going to take it smb fiddling with her bits? Sorry such a long post but am not able to think of anything else, and am afraid of making a wrong choice. Thanks to everyone in advance.

[BelleDeChocolateFluffyBunny]

Hi.

Does she have any problems with her kidneys? Any recurrent UTI's?

[MariaBN6]

Hi, thanks for your quick reply BelleDeChocolateFlyffyBun. She only had one so far a few months ago, but GP sent to an ultrasound which showed a duplex kidney.

[BelleDeChocolateFluffyBunny]

A duplex kidney in itself doesn't normally warrant any further investigations unless there's recurrent UTI's. Duplex kidneys are quite common and are rarely picked up unless the patient has recurrent infections or renal colic (kidney stones) as they show up on IVU's (where they inject a dye and take x-rays, like the one your daughter had but they take them more often to get an overwiew of how the kidneys are working). I'm sure they have a good reason to want to do further tests though but if it were my child I'd want to limit the amount of x-rays/general anaesthesia she has as much as I possibly could. They tend to give a little light sedation when they are doing a MCUG though so it's highly unlikely that she will remember anything.

[CharlieBoo]

Hi my ds had both the kidney scan with dye and the procedure to fill his bladder then xray it to show the reflux. His was negative for reflux but 6 months later he still had to have the kidney scan. He only had one uti too but he was only 5 weeks old and the infection was very significant they said, hence lots of tests. He was a baby so they did not sedate him for filling the bladder but it was a very quick process maybe only 5 mins and they tell you there and then the results. I am no expert obviously but if it were reflux then I'm sure you would have had more probs. This test would be reassuring for you and I agree the GA for the other test sounds extreme. Also I found the kidney dye test far worse than the filling the bladder one and you have already done that so take heart it's not that bad. Is your dd on trimethoprim? We have friends whose dd does have reflux and they have been reassured most children grow out of it. Hth xx

[MariaBN6]

Thanks BelleDeChocolateFluffyBunny and CharlieBoo. The reason why the doc wanted to have the cystoscopy is that he thinks it's best to eliminate any possibility of infection getting to kidney thru potential wider opening of the tube that links bladder with kidney, if there's reflux. If it is wider than normal he was going to 'narrow' it through an injection. However the urologist we went to see said that we can just do the MCUG which will show if there is reflux, and if there is none, we can carry on with our life and not find out about a wider opening. If there is no reflux at the moment, it is unlikely there will be any in the future. And I personally think since there is no damage to kidney at the age of 3.5 and only one UTI is there any point in cystoscopy?

Do you know what they use for sedating for MCUG, is it an injection?

Thank you.

[BelleDeChocolateFluffyBunny]

It will probably be medazolam, which is a bright green drink, it just makes them sleep. Girls can get UTI's, it's very common and doesn't necessarily mean there's reflux, the urethra and the anus are so close that bacteria can easily travel, especially in a little girl in a nappy. Kidney infections are a little different though as the becteria would have had to have travelled all the way up the urethra/ureter/bladder into the kidney so it's probably worthwhile checking for reflux in order to prevent further infections if possible.