Ureteral Narrowing: Kidney Damage and Treatment Options - Urology

The junction between the ureter and the kidney is narrowed, leading to renal damage?

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Dear Dr.
Liu,
I would like to describe my son's symptoms.
He is eighteen years old and has been experiencing pain in the right lower abdomen and groin since three years ago.
Recently, he has had episodes about once a month, with pain severe enough to cause vomiting.
Each episode lasts about 2-3 days before he returns to normal.
Given the proximity of the pain to the site of a previous hernia surgery in childhood, a physician at a small clinic recommended that we first consult a gastroenterologist.
However, after consultations at a major medical center's surgical and gastroenterology departments, no conclusive results were found.
Most recently, we consulted a urologist, and an ultrasound diagnosed severe right-sided hydronephrosis, indicating that the condition has been present for a long time.
Subsequently, renal imaging, CT scans, and endoscopic examinations were performed, leading to a diagnosis of obstruction at the junction of the right ureter and kidney.
The endoscopic examination could not pass through the obstruction, and the doctor suggested an MRI (which has not yet been performed) to confirm whether renal function is above 15%.
If it is, a ureter reconstruction surgery would be performed; if not, the recommendation is to remove the kidney.

I would like to know if it is absolutely necessary to remove the kidney if renal function is indeed below 15%.
Additionally, if the hydronephrosis and pain are caused by ureteral obstruction, why is there only pain in the right lower abdomen, with no discomfort in the kidney area? I found an article online by Dr.
Hong Zhengsheng from your hospital that describes a similar case to my son's.
Could you please provide an update on the condition of the eight-year-old boy mentioned in that article? Are there any other successful cases? After reading this article, I am very eager to refer my son to Yangming Hospital.
I sincerely hope you can help my child.
The article by Dr.
Hong Zhengsheng is as follows:
"Recently, in the Urology Department of Taipei Yangming Hospital, we encountered an eight-year-old boy who presented with abdominal pain.
After a series of examinations, it was confirmed that there was a narrowing at the junction of the ureter and kidney, resulting in severe hydronephrosis.
The most precise renal function test (DTPA nuclear medicine renal function scan) indicated that the renal function on that side was zero.
The family was very concerned and sought opinions from other physicians.
Since the patient lived near our hospital, they decided to proceed with surgery here.
However, they hoped to follow the recommendation of the outside physician to remove the non-functioning kidney that was causing abdominal pain.
This recommendation was reasonable, as generally, post-operative renal function only recovers slightly, and there are often complications such as urinary tract infections or stones.
Ultimately, not only does the renal function recover poorly, but it can also adversely affect the functioning kidney on the other side, making the removal of the non-functioning kidney a more definitive solution.
Dr.
Hong noted that while the renal function test is very precise, its accuracy diminishes in cases of severe hydronephrosis.
Therefore, the results of the renal function test should not be the sole basis for deciding whether to remove the kidney.
Other data should be considered, along with the physician's experience, to make a comprehensive judgment.
The CT imaging showed that there was still some renal parenchyma present, indicating that there might still be some renal function.
Dr.
Hong pointed out that the Urology Department at Yangming Hospital has accumulated years of experience in managing pediatric kidney diseases, and they have performed numerous surgeries for ureteral strictures.
Therefore, he suggested only removing the narrowed section while preserving the kidney.
The risks involved include potential complications and sequelae in the future.
However, the family insisted on removing the kidney.
Ultimately, the physician had to compromise and decided to assess the condition of the renal parenchyma during the surgery to determine whether to proceed with the nephrectomy.
During the surgery, it was found that the thickest part of the renal parenchyma was about 0.2 cm thick (which should be over 1 cm at this age).
Although there was only a small amount of function, considering the overall size of the kidney, it was deemed valuable to preserve it.
After much persuasion from the physician, the family finally agreed to take the risk of preserving the kidney.

Post-operative follow-up over the course of a year, using the same nuclear medicine renal function scan, revealed that the renal function had recovered to levels comparable to the normal kidney on the other side.
Currently, aside from moderate hydronephrosis, there are no other complications, and the renal parenchyma is now over 0.5 cm thick, which has brought great relief to the family, as they are grateful that the kidney was preserved.
This is a very unique and fortunate situation.
Generally, when people hear about hydronephrosis, they worry that the kidney will fail, leading to the need for dialysis or transplantation.
If someone experiences these symptoms, it can be very alarming.
Dr.
Hong believes that cases of hydronephrosis are quite common, occurring in about 1 in 500 individuals.
Most cases, after diagnosis and long-term follow-up, can maintain renal function.
A small number of cases can also preserve kidney function after surgical correction.
However, whether surgery is necessary or which type of surgery is most appropriate relies on accurate diagnosis."

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Qiujiu de muqin - ji urgent, 40~49 year old female. Ask Date: 2009/12/05