posted
This is as much me asking those who know (CT especially) as informing those who don't.
Mama and I were rather disappointed last week, because we had an appointment on Tuesday morning to see Mooselet's urologist at Children's Hospital L.A. I got a call Monday morning to tell us that due to an emergency surgery the doctor needed to perform, our appointment had to be pushed back to August 7th (though it later got shifted to the 5th). This has been tough on us, because a couple weeks prior we had tests done, and planned on having the doc tell us more about their results. Now we're just in limbo, and uncomfortable about it. We're trying not to think about it, but being somewhat unsuccessful.
He had two tests done -- an ultrasound of his kidneys, and a VCUG for his bladder and urinary tract. These are excerpts from the reports, and if someone can make us feel better about them we'd appreciate it....
quote:EXAM: ULTRASOUND KIDNEYS
INDICATION: UTI.
FINDINGS: The right kidney measures 6.4 cm and the left kidney measures 6.7 cm. In the upper pole of both kidneys are small hyperechoic foci in the kidneys. These may represent vascular interfaces. The possibility of a stone is raised but there is no shadowing associated with either of these hyperechoic foci. No mass or hydronephrosis is seen.
SUMMARY: Two hyperechoic foci detected within the kidneys, one approximately 3mm, the other approximately 1.5 mm, the larger being on the left side upper pole. The exact etiology is undetermined.
quote:EXAM: VOIDING CYSTOURETHROGRAM
INDICATION: UTI.
TECHNIQUE AND FINDINGS: . . . No evidence of reflux is detected. The bladder shows a coarse contour suggesting trabeculation. A small 5 mm diverticulum is again identified on the left side. No reflux is detected. The bladder neck is irregular. There is narrowing at the bladder neck and slight small tract is noted on the anterior aspect of the proximal urethra at the base of the bladder (2 x 0.5 mm). There is also suggestion of an impression on the proximal urethra on its posterior margin, the exact etiology is unclear. Distally the penile urethra is normal.
SUMMARY:
1. Deformity of the bladder neck with irregular contour of the anterior edge of the proximal urethra and an impression on the posterior aspect of the urethra which appears to be extrinsic. Clinical correlation is requested.
2. No evidence of reflux.
3. Prominence of the mucosal folds of the bladder raising the possibility of trabeculation and a degree of outlet obstruction. Prior examinations are unavailable for comparison at this time.
Good points -- no hydronephrosis, no reflux. But we have these concerns:
On the ultrasound, they indicate that the right is 6.4cm and the left is 6.7cm. On the last test, the right was 6.3cm and the left was 5.9cm. Is it likely that they mixed up left and right on one of the tests, or that they would grow so unevenly, and how concerned should we be?
Is there any way to tell from the report what the chances are that he has a kidney stone?
What is trabeculation?
How concerned should we be over a diverticulum? And the word I associate with this is diverticulitis -- how bad is that?
It sounds to us like there might still be a blockage, which makes us fear more surgery. Is that a reasonable understanding of this? Do repeated UTIs when he goes off prophylactic antibiotics make it seem more likely?
I realize that working from a report such as this and no other information means that any information provided could be inaccurate, but we're hoping for a little bit of comforting. Or at least, we'd rather know something than remain in the dark for another couple of weeks. It seems I invariably think of CT first when asking medical questions, but anyone who knows anything is more than welcome to pitch in.
Thanks, guys (please read as generic genderless term).
--Pop
[Edit -- changed thread title, since I don't specifically need CT's response any longer, though it's always nice to hear.]
[ August 05, 2003, 07:53 PM: Message edited by: Papa Moose ]
Posts: 6213 | Registered: May 2001
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posted
I'm really sorry that you guys have to be in limbo for another couple weeks. Beind in limbo is horrible.
I found some info. I hope it will be at least minimally helpful (until someone with better knowledge and info can help out).
Some info I found on trabeculation of the bladder: "Trabeculation is a cystoscopic finding of ridges or hypertrophy of the bladder seen in the wall. Trabeculation in itself is not a problem, particularly mild (1+) trabectulation, but it can lead to other problems if this condition become more severe. Occassionally, a heavy trabeculated bladder can be associated with reflux, diverticulae, or infection. Often, high pressures developing in the bladder from outlet obstruction or inappropriate emptying lead to the development of this condition."
From what I know about kidney stones (which isn't a whole lot, but my mother has had them several times), that report isn't enough to say whether he does or doesn't have them. It only mentions "hyperechoic foci", which are a kind of mass (sometimes a fatty tumor - benign) that can pop up almost anywhere in the body. Without knowing exactly what they are made of, you can't tell if it's a kidney stone or not. It is good news that there was no evidence of reflux in the bladder checks (which can happen with kidney stones).
From what I understood in reading these reports, he doesn't necessarily have a blockage, but there are conditions (the various folds and narrowing) which makes him more prone to obstructions.
I'll be praying for all of you. I hope that things will be worked out quickly for him (and for you and Squirrel). Posts: 5879 | Registered: Apr 2001
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posted
Mooselet has had many UTIs -- the latest was about a month ago (might have been two different ones overlapping, actually), a couple months after his pediatrician had him try going off the antibiotics again.
Lusti, thanks for the info, links, and prayers. We'll let you know next time we'll be in Arizona, ok?
Posts: 6213 | Registered: May 2001
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posted
Not too sure about CT's internet access availability right now. She's away again for a week. I'll let her know to check this thread, though, if I talk to her!
Sorry to hear about the delay. I'm no help with medical terms, sadly.
Posts: 1777 | Registered: Jan 2003
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I think I feel better just having stated my concerns -- one of those get-it-off-my-chest things. Less limbo.
Posts: 6213 | Registered: May 2001
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You guys better let me know next time you're in my state or I'll have to come to CA just to kick your butt! Posts: 5879 | Registered: Apr 2001
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posted
Hee hee... I just checked your e-mail so I could e-mail you Theca's IM. Nothing like a self referential webage! Orphanage administrator eh? Nothing like foreshadowing either!
posted
Papa Moose, it looks like fantastic results to me. Everything -- I think -- looks like it is within normal variation or not immediately concerning, but I haven't done the calculations. It's hard to go on someone else's interpretation without the images in front of me, but I'd be frankly delighted to read this report on one of my kids. Basically, there is no immediate damage being done, and nothing important that is irreversible.
There are some subtle changes, though. Has anyone yet mentioned the possibility of posterior urethral valves? It's a developmental anomaly -- found only in boys -- where little flaps of tissue can trap urine in the bladder. Trabeculations and some of the other positive findings would be consistent with a very mild form of PUV. However, espscially given his history of multiple UTIs, whatever it is would probably need to be corrected surgically (otherwise long-term kidney damage could result). This would be an outpatient or single-day surgery, though.
Of course, I'll defer to your specialists in all things, and these are just guesses. But I think he may have the most common and easily treatable cause of multiple UTIs, one that is easily repaired, and which has caused no lasting damage whatsoever.
He had posterior urethral valves. He had them resected last October, along with the reversal of his vesicostomy. We're currently hoping to avoid the need for another surgery, seeing as he wasn't incredibly fond of all the other ones (nor were we, it just so happens). But it's encouraging to know that you consider these reports to be favorable. Thanks again for the reply.
posted
You know, Papa, it sounded familiar, and I remembered that he'd had a vesicostomy, although I couldn't remember the diagnosis. This time -- if they do surgery -- they may be able to justgo through the urethra with a tiny camera and itty bitty laser/scissors. Much easier healing than being opened up from the outside.
Bottom line: still getting UTIs = something not right with the plumbing, but looks favorable so far. Thank goodness you have good specialists.
Give him a hug for me. Posts: 14017 | Registered: May 2000
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posted
I'm trying to figure out how one can think entering one's body through the urethra can be in any way considered non-invasive. It's like Dennis Miller's comment on Monday Night Football -- is there really such a thing as a minor groin injury? Nothing's minor there....
Yes, from a surgical and health standpoint, it does sound much less invasive, and I'll be glad if the opportunity is there. Thanks again, all, for your well-wishes and prayers. And Mooselet isn't allowed at Ornery for a long, long time. I'm certain he'd get complaints that he can't possibly know anything, since he hasn't lived a full enough life yet. And for him, there's even some validity to the claim, I suppose.
posted
Ok, things are pretty good. I posted here first, but thought it belonged here, too.
Well, the urologist at Children's Hospital is very happy about all Mooselet's test results. We felt a little rushed, and forgot to ask all our questions (write 'em down!), so there are still things of which we're uncertain. But apparently none of them are by any means crucial.
The most important thing as far as the doc was concerned was that there was no dilation, indicating that there wasn't a remaining blockage, at least not to an important degree. Mooselet is staying on the antibiotics at least until the next appointment (November), for which we'll be doing another ultrasound but not another VCUG -- big "yay" from Mooselet on that one.
However, when we got home from the appointment, I took his temp, and it was 103.3 (a pretty good radio station, but a bad fever). It was around 101 last night, and we gave him Tylenol followed by Motrin a few hours later. 100.4 when he woke up this morning, and he was in a good mood. Not so much when we got home.
Doesn't appear to be another UTI (based on the urine dip), but they're doing a culture anyway. Because of his history with them, we can't be too careful.
Other side note of good news -- the urologist at Children's Hospital is going to begin working out of an office that's about 20 minutes from our home instead of the hour (only in trafficless L.A., not always available) to Children's. That will make future visits much easier, and for that we are thankful.
Thoughts and prayers for those Hatrackers still hurting. (((Y'all)))
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I'm so glad to hear that the news was pretty good!!
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Good news is always...well, good.
