Q: My 6-month-old son was detected with grade III urinary reflux when he was 3 months old. He has urinary tract infection. He is currently on antibiotics (Bactrim 2.5 ml daily). The ultrasound report says that the kidney size is fine. We will get the nuclear medicine test (DMSA) done in a months time. He has had two urinary infections. When and how will the problem heal up? Does he require surgery? Off late he has started grasping and snatching his penis quite a lot. Is it related to some irritation and means another infection? He puts lot of pressure while passing urine (as if passing stool). Is this normal or an important symptom?

A:Your son is on right treatment. DMSA is important to see any damage. It is important to check if it is present on one or both sides. If you think he is pulling his penis, see if the skin (prepuce) is clean. If not, pull as much possible back and clean with plain water. If his urine stream is good, no worry for straining. But most important is to rule out posterior urethral valves. For that initial MCU is enough. If DRCG was done to diagnose reflux, please get conventional MCU. Get ultrasound for kidney growth every month and a urine routine test every month. If he has fever due to any cause, get extra urine routine/microscopy test and may be a culture. If he keeps getting infection, get him operated.