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reimplantation surgery in adults
Posted By Ginger Pinholster on November 20, 1998 at 15:28:06:

Dear Doctor,
I'm a 38-year-old woman, and I urinate approximately every 20 minutes. About 15 years ago, I sought help for this problem and was told, after undergoing cystoscopy, that I had interstitial cystitis. I gave birth to a healthy daughter in 1992, but my urinary problems seemed to become markedly worse at that point. Earlier this year, I began to have extreme pain with urination and some whitish discharge. Urinalysis showed first an e. coli infection, then streptococcus species, then e. coli again, etc., etc. Because my urinalysis was sometimes clear even when I reported symptoms, my family doctor suggested that I was "just stressed out by a couple of simple bladder infections."
A second doctor ordered an IVP-VCUG, which showed Grade III reflux. An ultrasound showed a significantly deformed and atrophied left kidney. A subsequent renal scan gave the differential functioning as 28 percent on the left and 72 percent on the right. I'm now waiting for the results of a cystoscope biopsy of fluid from both kidneys, as my urologist wants to check for chronic pyelonephritis.
He has said that, unless the test shows bacteria deep in the kidneys, he would not consider ureter reimplantation surgery because "there's no guarantee that this procedure would address your symptoms." He would prefer that I take an antibiotic daily for the rest of my life. Yet, urinalysis in the past isn't always positive even when I'm having symptoms, which include flank pain and painful/frequent urination as well as severe chills -- but not fever. This leads him to believe that I don't have pyelonephritis.
I'm very concerned about protecting the health of my right kidney, and preventing any further damage to the left kidney. I need to find some information on whether reimplantation surgery is, in fact, believed to help prevent kidney infections. I haven't been able to find much info on reflux in adults or reimplantation in adults.
So, I have two questions: (1) is it possible for pyelonephritis to be "subclinical," or lurking undetected, even when a urinalysis is clear; and (2) do most doctors feel that reimplantation can help prevent kidney infections, or is this debatable?
Thanks for any information you can share.

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