ureter obstruction

[jep67]

my 10yr old daughter had ureteroscopy proecedure in Oct08 for stone removal on her right kidney then had the stent removed 6 wks later. Then our troubles started because retrograde pyelogram showed distal ureteral dilatation. This means that the flow of urine to the bladder is not normal and there is narrow passage close to the bladder. In Dec, ultrasound showed hydronephrosis and hydroureter with stones again in the lower pole of the kidney. Nothing was done other than observation. In Jan, a bunch of small stones passed naturally. Last week, Feb, a mag3 renal scan and ultrasound were done that showed hydronephrosis and hydroureter still present but no stones in the kidney. The uptake and washout of urine from the kidney was slow compared to the other kidney (about 70% vs 30% function for good and bad kidney instead of 50-50). So clearly there is a ureter obstruction. Now the urologist wants to do a retrograde pyelography to really determine the cause of the obstruction, whether it's a stone or stricture. My question is that, what's the likelihood it is a stone or a stricture? She was able to pass stones weeks earlier though the partial obstruction is still there. She has no symptoms or pain. Is it a good idea to do the pyelography now or wait for a few more weeks hoping that it will heal itself. thanks...

[Dr_Veena]

Hi,
     Thanks for writing in. Stones in the kidney if less than 4mm pass out spontaneously, but stones larger than this size or even smaller, but symptomatic stones usually require intervention.
In your child’s case there is clear evidence of involvement of the kidney (hydronephrosis)  due to obstruction, which may be in form of stone or stricture. Retrograde pyelography is a series of x-rays taken after introduction of dye while doing a cystoscopy, which gives information about renal pelvis, ureters and bladder.
Delaying this procedure will only deteriorate the function of the kidney and delay in treatment.
Best.

[jep67]

got the news and it's not good. she has a stricture at the distal ureter and has scar tissues on the portion close to the renal pelvis. The ureteroscopy last Oct resulted in urinoma which might have cause the scar tissues on the upper part of the ureter. The doctor is now suggesting ureter reimplantation which is scary. What's your opinion of this? can this be resolved by stenting?