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DISORDER OF THE KIDNEY AND URETERS

UNDERSTANDING THE PROBLEM

The kidneys are two small fist-sized organs located behind the abdomen on each side of the spine. By producing urine, kidneys remove toxic by-products and excess fluids from the body to help maintain a critical balance of salt, potassium and acid. The kidneys filter the blood to produce urine. The ureters are two thin tubes about eight to 10 inches long that carry urine from the kidney to the bladder. Most often ureter disorders result from obstruction or injury. When urine is backed up, a urinary tract infection may also occur. The urinary system is the body's drainage system for removing wastes and extra water.

The most common urologic disorders are from infectious, inflammatory conditions or conditions from a previous surgery or congenital abnormalities. Those that affect the kidneys are dangerous because damage to the nephrons can result in permanent renal dysfunction.

These could include Congenital stenosis / Ureteral Junction Stenosis - Pyelo-Ureteral Junction Stenosis (PUJS), forms of Kidney Blockage/Obstruction, Pyelonephritis (Kidney Bacterial Infection); Kidney Cysts amongst others. These condition are described further below.

UNDERSTANDING WHO SUFFERS

Disorders and diseases of the kidney are found more often in racial and ethnic minority populations in the United States than in the Caucasian population. Research indicates that African Americans, Asian Americans, and Hispanics are three times more likely to suffer from kidney failure than Americans of European descent. One in 10 American adults, equating to more than 20 million people, have some level of Chronic Kidney Disease (CKD).

POTENTIAL SIGNS AND SYMPTOMS

Adults with UPJ obstruction can present with various symptoms, including:

  • back and flank pain
  • Urinary Tract Infection (UTI) and/or pyelonephritis
  • hematuria
  • urosepsis
  • a palpable mass.

UPJ obstruction may also cause pain without an infection.

UPJ after birth, signs in infants and children are:

  • abdominal mass
  • urinary tract infection with fever
  • flank pain (pain in the upper abdomen or back, mostly with fluid intake)
  • kidney stones
  • bloody urine
  • vomiting
  • poor growth in infants

UPJ obstruction may also cause pain without an infection.

Pyelonephritis may start with similar symptoms. However, once the infection has spread to the kidney, signs of more severe illness usually result. They include:

  • Back pain or flank pain
  • Fever (usually present) or chills
  • Feeling sick (malaise)
  • Nausea and vomiting
  • Confusion (especially in the elderly)

Pyelonephritis may cause noticeable changes in the urine, such as:

  • Blood in the urine (hematuria)
  • Cloudy or foul-smelling urine
  • Pain when urinating
  • Increased frequency or urgency of urination

Simple kidney cysts usually do not cause symptoms. However, symptoms may include:

  • Cause pain in the side, back, or upper abdomen if they enlarge and press on other organs
  • Bloody urine
  • Become infected, causing fever, chills, or other signs of infection
  • Impair kidney function (rare)

Simple kidney cysts have been associated with high blood pressure, but it is unclear what the relationship is between the two.

EXAMINATIONS USUALLY REQUIRED

While ultrasound help doctors see the kidneys, more tests are needed to confirm UPJ obstruction.
To make a proper diagnosis, urologist must see how well urine is produced and drained. There are several tests that can be done.

  • Blood samples and urine samples may be taken. The BUN (blood urea nitrogen) and creatinine tests find if the kidney is working well as it filters the blood.
  • An intravenous pyelogram (IVP) was often used in the past. In this test, a dye is injected into the bloodstream. An X-ray is used to see the kidneys remove the dye from the blood. As the dye passes through urine, doctor can see if the kidney, renal pelvis and ureter look normal.
  • A nuclear renal scan is similar to an IVP but is more modern. This test uses radioactive material instead of dye. The material can be seen with a special camera. This test gives the doctor good information about how the kidney is working and how much blockage there is.
  • CT scans are sometimes used in the emergency room to find out why children are having severe pain. A CT scan can easily show the obstructed kidney if that is the cause of the pain. Magnetic resonance imaging (MRI) is also used to look at the kidneys, ureters and the bladder.

Doctors may rely on various tests to diagnose pyelonephritis:

  • History and physical examination.
  • Urinalysis. In pyelonephritis, microscopic analysis of the urine virtually always shows signs of infection. This can include an excess of white blood cells and bacteria.
  • Urine culture. Within days, bacteria in urine may grow on a culture dish, allowing the best antibiotic to be chosen.
  • Kidney ultrasound. A probe directs high-frequency sound waves through the skin, creating images of the kidneys and ureters. Ultrasound can help identify abscesses, stones, and blockages.

In general some of the following tests below can be requested dependent on condition:

  • Abdominal CT scan
  • Abdominal MRI
  • Abdominal ultrasound
  • Angiography of the kidney artery or vein
  • Blood electrolytes
  • Blood tests to look for toxic substances
  • Urine Samples
  • Complete blood count (CBC)
  • Intravenous pyelogram (IVP)
  • Kidney function tests
  • Retrograde pyelogram
  • Kidney x-ray
  • Renal scan
  • Urinalysis
PROPOSING TREATMENT AND WHY AIMIS

 

Surgery for Kidney disorder or Urinary Obstruction

If your doctor recommends surgery for a kidney disorder or urinary obstruction, you may be a candidate for a minimally invasive approach - da Vinci Surgery. AIMIS is an expert in Robotic Surgery for Robotic Assisted partial or radical Nephrectomy and other disorder of the Kidneys and ureters involving the best American and International surgeons who are experts in the field.

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for kidney and ureters and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • High likelihood of kidney preservation, if any.
  • Shorter ischemia time better for the renal function
  • Less blood loss
  • Less pain
  • Minimal scarring
  • Lower risk of complications and significantly reduced risk of major complications
  • Shorter hospital stay
  • Faster recovery and return to normal activities

Da Vinci Surgery incorporates the best techniques of open and laparoscopic surgery and applies them to a robotic-assisted, minimally invasive approach for treatment of non-cancerous kidney disorders or urinary obstruction..

To see the procedures we undertake with Robotic Xi Surgery, please click here

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

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AFFORDABILITY

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

Urinary Obstruction

One of the most common conditions affecting the kidneys is urinary obstruction. Obstruction can occur anywhere in the urinary tract and when it occurs, medical attention is required. A urinary obstruction can create serious side effects like infections and kidney stones. If left untreated, blockages can cause chronic pain and may damage the kidney over time.

Blockage of the Ureter

The condition known as blockage of the ureter (tubes that transport urine from the kidneys to the bladder) is found in adults, but more commonly in children. Normally, a single ureter drains a single kidney but sometimes there may be two ureters draining one kidney. One ureter drains the upper part of the kidney and the second ureter drains the lower part. As long as they both enter the bladder normally, this ""duplicated collecting system"" is not a problem. The most common cause of urinary obstruction in adults is kidney stones, although an injury or other conditions could cause the obstruction.

UPJ Obstruction

The most common cause of obstruction in the urinary tract in children is a congenital obstruction. This occurs at the point where the ureter joins the renal pelvis (called the ureteropelvic junction or UPJ). This is the area at the center of the kidney where urine collects and is funnelled into the ureter. This type of obstruction occurs in roughly one in 1,500 children.1 These obstructions develop prenatally as the kidney is forming. Today, most cases are diagnosed on prenatal ultrasound screening. Although much less common in adults, UPJ obstruction may be caused by kidney stones, previous surgery (ies) or disorders that cause inflammation of the upper urinary tract.

Pyelonephritis

When the urinary tract is of unusual size or shape, it is more likely that infections can lead to acute pyelonephritis. Anyone with chronic kidney stones or other kidney or bladder conditions are also at risk. . Whenever there is a problem that interrupts the normal flow of urine there is a greater risk of acute pyelonephritis. Pyelonephritis is a serious infection that for acute cases treatment with antibiotics is required. Hospitalization isn't required unless severe pyelonephritis occurs. In rare cases, pyelonephritis may progress to form a pocket of infection (abscess). Abscesses are difficult or impossible to cure with antibiotics alone and must be drained. Most often, this is done with a tube inserted through the skin on the back into the kidney abscess (a procedure called a nephrostomy).

Kidney Cysts

A simple kidney cyst is a round pouch of smooth, thin-walled tissue or a closed pocket that is usually filled with fluid. One or more may form within the kidneys. Simple cysts are the most common type of kidney cyst. They are not the same thing as polycystic kidney disease, which is a progressive disease that can lead to kidney failure. Simple kidney cysts most often do not cause harm. In cases that Cysts, cause symptoms or complications surgery maybe recommended drain the fluid from the cyst and remove or burn its outer wall to keep it from reforming.

FURTHER INFORMATION ON INCREASED RISK GROUPS

UPJ Obstruction

UPJ obstruction presents most frequently in childhood, but adults and elderly individuals can also present with a primary obstructive lesion. In adults, other etiologies for ureteral obstruction must be considered, including stones, ureteral compression due to extrinsic processes, retroperitoneal fibrosis, and other inflammatory processes.

Pyelonephritis

As with ordinary urinary tract infections bacteria found in stool (such as E. coli or klebsiella) and bacteria from the skin or the environment increase the risk factors of pyelonephritis
Conditions that create reduced urine flow make pyelonephritis more likely. When urine flow slows or stops, bacteria can more easily travel up the ureters.

Some causes of urine obstruction include:

  • Benign prostatic hypertrophy (BPH)
  • Abdominal or pelvic masses (as from cancer)
  • Stones in the bladder, ureters, or kidneys

Kidney stones contribute to pyelonephritis by providing a place for bacteria to grow while evading the body's defenses.

Kidney Cysts

Being male and aged 50 or older increases the risk factors of simple kidney cysts

FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

Further examinations:

  • Multidetector CT scanning with 3-dimensional reconstruction can be particularly helpful in establishing the anatomy of UPJ obstruction, revealing an intrinsic or high-insertion UPJ. Crossing vessels and their relationship to the ureter of the UPJ can also be evaluated. The location of these vessels and their possible contribution to renal obstruction can help the surgeon clinically decide whether endopyelotomy, open pyeloplasty, or laparoscopic pyeloplasty would be the most effective treatment modality.
  • In addition to diagnosing pyelonephritis itself, doctors look for any conditions that make pyelonephritis more likely. For example, kidney stones or birth defects of the urinary tract can increase the chance of an infection. Both are potentially correctable, which will reduce the chances of future kidney infections.
  • Computed tomography (CT scan). A scanner takes a rapid series of X-rays, and a computer creates detailed images of the abdomen and kidneys. A CT scan is not necessary to diagnose pyelonephritis, but sometimes helps.
  • Blood cultures. If pyelonephritis has spread to the blood, blood cultures can detect this and guide treatment.
  • Presence of diabetes, blood pressure and other conditions
WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Robotic Assisted partial or radical Nephrectomy and other disorder of the Kidneys and ureters involving the best American and International surgeons who are experts in the field.

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for kidney and ureters and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • High likelihood of kidney preservation, if any.
  • Shorter ischemia time better for the renal function
  • Less blood loss
  • Less pain
  • Minimal scarring
  • Lower risk of complications and significantly reduced risk of major complications
  • Shorter hospital stay
  • Faster recovery and return to normal activities

Da Vinci Surgery incorporates the best techniques of open and laparoscopic surgery and applies them to a robotic-assisted, minimally invasive approach for treatment of non-cancerous kidney disorders or urinary obstruction.

OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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