A Case of Vesico-Ureteric Reflux

Case Record

Name: Mast. A. A. K

Age: 5 yrs, sex – male

Address: Ramnagar, n – 2 Cidco, Aurangabad

Date: 12/01/2010.

 

K/C/O – Vesico- Ureteric Reflux.

History of chief complaints:

C/o burning pain during and after micturition.

E/o phimosis but no ballooning at glans during urination.

H/o recurrent fever coryza

no H/o any surgery.

Pain at paraumbilical region after eating for 2-3 min.

Cough since 1 day with fever in last night.

H/o fever after fright in the past, 2 – 3 times.

Family history:

Father – healthy

Mother – healthy

G.father – CA larynx

G.mother – CA cervix

Past history:-

No major illness in past.

H/o vaccination.

Personal History:

Appetite – normal

Aversion – sweet, fruits, sour, eggs, coconut water.

Desires – potato, pungent, sago+++, poha++, rice-dal, chalk, pencil.

Perspiration – face & scalp.

 

Mentals:

yielding +

obstinate +

fear of urination ++

O/E :

chest – clear / aeebs.

tongue – clean

skin – dry

Investigation:-

USG abdomen & pelvis (12/11/2009): –

Mildly dilated pc system of left kidney? reflux uropathy ? cause.

Mild changes of cystitis.

Normal right kidney, no posterior urethral valve. No significant post void residue.

Micturating cysto-urethrography (12/11/2009): –

S/o bilat. gr. 1 – 2 vesico-ureteric reflux.

No e/o posterior urethral valve.

No significant post-void residue.

Video c.u. scopy by Dr. R.J.Totla (24/11/2009) :-

Anterior urethra normal, posterior urethra normal, bladder neck normal, bladder wall smooth, mucosa normal.

Bilateral wide open ureteric orifices as if they can admit a scope also.

Tunnel length small. Rest normal.

Diagnosis of disease : –

VUR grade 3 – 4.

Diagnosis of phase of disease: –

chronic reversible.

Diagnosis of miasm : –

dominant – sycotic

fundamental – syphilitic

Diagnosis of susceptiblity : –

moderate.

Diagnosis of remedy : –

nat.carb, carcinosin, cantharis, tuberculinum, cal.phos, alum, borax.

Selection of remedy : –

Borax 200 0ne dose.

follow up:-

date	observation and investigation done	remedy given
19/1/2010	pain at paraumbilical region remain for 2 – 3 min < eating. no pain during micturition. cough with expectoration, white expectoration. h/o fever 2-3 times but >>>. cough < morning, > day time. 2-3 times urination in night, not any pain during urination.	s.l
01/02/2010	no cough, no coryza. pain in abdomen at para umbilical region after full eating, it remains for 1 – 2 minutes, but not if he eats slightly. no pain during micturition. appetite improved.	s.l
13/02/2010	once pain during micturition. USG – abdomen = mild pcs fullness left kidney ? cause. rest normal.	s.l
17/02/2010	h/o drinking coconut water 4 – 5 days back. fever since last afternoon. temp – 101.4 f, p.r 120/min. h/o coryza with cough since 2 days. h/o pain during micturition. o/e tongue white coated. parents gave history that he had same type of fever and cough and coryza recurrently since last 4 – 6 months.	calc. phos – 200 1 dose.
26/02/2010	no fever, appetite improved. cough since 7 days. chest – coarse crepts on both sides. mild coryza. no pain in abdomen, no burning micturition.	calc. phos – 200 1 dose
10/03/2010	no pain during micturition, no pain after eating. no cough, no coryza. chest clear.	s.l
22/03/2010	appetite improved. once pain during micturition. no fever/ cough/ coryza. thirstlessness	tuberculinum – 1m 1 dose.
5/04/2010	no pain during micturition. 2 times pain in abdomen after eating. no cough/ coryza.	s.l
20/04/2010	h/o pain in right testis. o/e testis normal. no pain during micturition / after eating. no h/o recurrent coryza / cough / fever. USG – abdomen = normal study.	s.l
10/06/2010	no complaints	s.l
10/08/2010	no complaints	s.l
14/10/2010	acute episode of acute appendicitis, and we decided for appendisectomy with circumcision.	s.l
18/11/2010	no  complaints. PET scan for VUR – no scan evidence of Vesicoureteric reflux.	s.l

Scanned reports of – USG abdomen & pelvis , micturating cysto – urethrography, video c.u. scopy and pet scan for VUR are given below:-

Before treatment :-

Photographs of MCU films with reports before treatments:

Pre-void image, during void images and post-void image.

Scanned copy of video cysto-urethroscopy done by Dr. Totla.

After treatment :

USG abdomen & pelvis :

– normal study

Scanned copy of PET scan for VUR done by Dr. Shrikant Solav:-

No scan evidence of vesicoureteric reflux.

Comments:

The aim of treatment was not only relief of pain during urination, but to avoid VUR. Pain during urination was due to his phimosis. Phimosis will not create VUR, but it could be due to prolonged holding of urine in the bladder, as due to phimosis he was having dysuria.

Initially Borax was given, since the patient was having fear of passing urine, and I thought it was the best remedy for him, as it acted well. After that he had no pain during urination, but after a few weeks, he had an acute episode of coryza with fever, where he was given Calcarea phosphorica After the second dose of Calc phos and one dose of Tuberculinum, he did not have any recurrence of coryza and fever, even after getting wet in the rain.

He was occasionally having pain during urination, and he also had an episode of acute appendicitis, for which he underwent surgery during the same time his circumcision was done. Then he went for Petscan for VUR, and no evidence of VUR was detected.