Friday, November 5, 2010

Logan Update

Well the results of the kidney test came back not so good. It seems that the *good* kidney is doing 79% of the work and the other kidney is doing only 21% of the work. Because its higher than 15% they want to try and save that kidney. During the test it seemed as if they kidney wasn't draining like it should have and the test results proved that.
On November 23, they are going to put Logan to sleep and use a camera to see if there really is a blockage, if there isn't then great and we can go home.
If there is a blockage then while they are in there, they will use a balloon like thing and inflate the ureter tube and put in a stent. The stent will have to stay in there for at least 4-6 weeks.
We are hoping this procedure works, because if it doesn't they will have to redo the surgery that he had last year. If that doesn't work then they will just take out the kidney.
It should be just a same day procedure and he will be able to go home at the end of the day.
If you are curious here is some information about whats going on.
Info Below about his kidney: from Childrens Hospital Boston

Ureteropelvic Junction (UPJ) Obstruction

Ureteropelvic Junction (UPJ) Obstruction

What is ureteropelvic junction (UPJ) obstruction?

UPJ obstruction occurs when there is an abnormal narrowing of the ureter at the level where the kidney pelvis and the ureter meet (See Urinary Tract, Normal Anatomy). This abnormal narrowing impedes the flow of urine down the ureter and into the bladder, causing the urine to build up, resulting in a condition known as hydronephrosis, an expansion and dilation of the renal pelvis.

The degree of obstruction at the ureteropelvic junction varies widely, ranging from very mild to very severe. In general, mild cases of UPJ obstruction do not injure or impair the kidney from performing its normal function. Mild UPJ obstruction may, however, predispose a child to increased risk of urinary tract infection. In severe cases of UPJ obstruction, there can be significant impairment or renal damage.

What causes UPJ obstruction?

There are two types of causes of UPJ obstruction, intrinsic causes and extrinsic causes. The intrinsic cause, which is the most common type occurs during fetal development, resulting in a narrowing of the ureter as it's forming, leading to the blockage of urine flow. Extrinsic causes can include an abnormal tethering of the ureter by abnormal blood vessels or compression of the ureter by a tumor.

What are the symptoms of UPJ obstruction?

Most cases of UPJ obstruction are now diagnosed prenatally, due to the common practice of prenatal ultrasound. If the condition is not detected before birth, a child may have the following symptoms: hematuria (blood in the urine), urinary tract infection, abdominal masses or abdominal discomfort.

How is ureteropelvic junction obstruction diagnosed?

In many cases, the condition is diagnosed by prenatal ultrasound. The fetal kidney and collecting system are often detectable on prenatal ultrasound as early as 15 weeks of gestation. The first sign of a problem on the ultrasound is usually hydronephrosis, which is an indication that there may be a blockage of urine flow. You may undergo further ultrasounds during pregnancy, and your baby will be evaluated after birth.
You would also be referred to a pediatric surgeon if your child displays any of the symptoms described above. If the specialist suspects UPJ obstruction, your child will undergo the following tests:

Renal-bladder ultrasound: This is generally the first test performed. The ultrasonographer will be looking to see if the renal pelvis is dilated and if there is any damage to kidney function. The doctor will be able to determine whether the condition is mild, moderate, or severe.
Voiding cystourethrogram:This test is used to determine whether there is vesicoureteral reflux or obstruction below the bladder.
Intravenous Pyelogram (IVP) or Renal Scan: Either of these tests may be performed based on the surgeon's preference. Both tests help to evaluate the severity of obstruction of urine flow from the kidney to the bladder.

Based on the findings of the tests described above, a determination will be made as to whether the condition represents a severe or mild degree of UPJ obstruction, whether it can be safely watched to see if it resolves spontaneously or whether it would be treated best with surgical correction.

How is ureteropelvic junction obstruction treated?

UPJ obstruction can occur in varying degrees of severity. In its very mildest nature, it is most often left alone, with routine observation, since it can correct itself over time. In severe cases of UPJ obstruction, there may be concern about impairment of kidney function or permanent kidney damage and therefore these cases are treated surgically.
The operation usually involves removing the narrow part of the ureter and re-connecting it to the kidneys drainage system, a procedure known as pyeloplasty. This is sometimes done laparoscopically. See Pyeloplasty (laparoscopic).