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Stomach Pain Near Left Kidney And Sometimes Low BP. Urologist Has Recommended For Pyeloplasty Operation. What Are The Upcoming Risks?
Question: Hi doctor,
My mother for past 6 months has been suffering from periodic pain in her stomach near her left kidney. At couple of occasions her BP too had fallen dramatically to 60/40 and had to be rushed to ICU (probably for the same reason, but doctors haven't been able to assert). The kidney functionality tests have shown that her left kidney is 33% and her right kidney is 66%. But apparently her right kidney is compensating for the left, so her serum urea and serum creatinine levels are normal. Our consulting urologist have recommended her to go for pyeloplasty operation to remove the obstruction in her urethra. I would like to understand her situation. Is the operation really mandatory for her? (as doctor says her kidney functionality might deteriorate further if the obstruction is not surgically removed). How critical and risky is the operation? Is a common operation? Is the robotic pyeloplasty available in India?
My mother for past 6 months has been suffering from periodic pain in her stomach near her left kidney. At couple of occasions her BP too had fallen dramatically to 60/40 and had to be rushed to ICU (probably for the same reason, but doctors haven't been able to assert). The kidney functionality tests have shown that her left kidney is 33% and her right kidney is 66%. But apparently her right kidney is compensating for the left, so her serum urea and serum creatinine levels are normal. Our consulting urologist have recommended her to go for pyeloplasty operation to remove the obstruction in her urethra. I would like to understand her situation. Is the operation really mandatory for her? (as doctor says her kidney functionality might deteriorate further if the obstruction is not surgically removed). How critical and risky is the operation? Is a common operation? Is the robotic pyeloplasty available in India?
Hi
There are a couple of questions that need to be answered here. PUJ obstruction is not an uncommon entity and if the relative function is 33% then a pyeloplasty should help in relieving the obstruction in over 90% of patients. Robotic pyeloplasty is available at several centers like medanta in Delhi and MPUH in Nadiad near Ahmedabad. The question that I feel should be answered here is 1) is the pain due to the kidney issue and 2) is there any infection in the obstructed system in which case a preliminary drainage with a stenting may be useful to prevent post operative sepsis. Both of these questions should be easily answered by any astute urologist after a clinical examination.
Hope this answers your query.
There are a couple of questions that need to be answered here. PUJ obstruction is not an uncommon entity and if the relative function is 33% then a pyeloplasty should help in relieving the obstruction in over 90% of patients. Robotic pyeloplasty is available at several centers like medanta in Delhi and MPUH in Nadiad near Ahmedabad. The question that I feel should be answered here is 1) is the pain due to the kidney issue and 2) is there any infection in the obstructed system in which case a preliminary drainage with a stenting may be useful to prevent post operative sepsis. Both of these questions should be easily answered by any astute urologist after a clinical examination.
Hope this answers your query.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor,
Thanks a lot for your reply. I will check with my urologist on the two points you have raised. But until now no biopsy has been done to find infection in the PUJ, and our urologist is correlating the pain with kidney by observing the CT Scans, is there other way to confirm?
I had a couple of other questions too-
1. She has periodic pains in her stomach, is that the only symptom to PUJ obstruction?
2. Will her kidney functionality deteriorate if its not operated?
3. Will it improve if the PUJ obstruction removed?
4. Is there no medication to help her PUJ obstruction?
5. As of today, will pyeloplasty be the best solution to her problem?
Regards,
XXXX
Thanks a lot for your reply. I will check with my urologist on the two points you have raised. But until now no biopsy has been done to find infection in the PUJ, and our urologist is correlating the pain with kidney by observing the CT Scans, is there other way to confirm?
I had a couple of other questions too-
1. She has periodic pains in her stomach, is that the only symptom to PUJ obstruction?
2. Will her kidney functionality deteriorate if its not operated?
3. Will it improve if the PUJ obstruction removed?
4. Is there no medication to help her PUJ obstruction?
5. As of today, will pyeloplasty be the best solution to her problem?
Regards,
XXXX
Brief Answer:
Hi, I have written a detailed answer
Detailed Answer:
Hi,
I will answer your questions as you had asked:-)
Without clinical examination, it will be difficult to say if a particular pain is due to PUJ Obstruction or something else. This is a slowly progressive disease, and therefore is unlikely to cause significant pain suddenly, and so if you have doubts, i would not mind asking a gastroenterologist to have a look to ensure we do not mis other problems.
Kidney function deterioration does happen if the obstruction is severe. Usually this is a silent progression, and if the kidney remains un-operated you might have to keep getting nuclear scans periodically to ensure you do not miss the deterioration as and when it might happen. There are some patients who do have stable disease, i.e an obstruction which has been compensated by natural means but for this we need to see the renograms and the curves that are attached with the films.
If the pain is due to PUJ Obstruction, her pain should improve after a successful surgery.
As of now, the only medications are for pain relief. Obstruction does not go away with drugs.
Pyelopasty is an excellent option, and depending on local anatomy can give success results in excess of 90%. You need not go for robotic pyeloplasty. Laparoscopy gives equally good results and should be available easily at most major urban centres.
Hope I have been able to help you.
Hi, I have written a detailed answer
Detailed Answer:
Hi,
I will answer your questions as you had asked:-)
Without clinical examination, it will be difficult to say if a particular pain is due to PUJ Obstruction or something else. This is a slowly progressive disease, and therefore is unlikely to cause significant pain suddenly, and so if you have doubts, i would not mind asking a gastroenterologist to have a look to ensure we do not mis other problems.
Kidney function deterioration does happen if the obstruction is severe. Usually this is a silent progression, and if the kidney remains un-operated you might have to keep getting nuclear scans periodically to ensure you do not miss the deterioration as and when it might happen. There are some patients who do have stable disease, i.e an obstruction which has been compensated by natural means but for this we need to see the renograms and the curves that are attached with the films.
If the pain is due to PUJ Obstruction, her pain should improve after a successful surgery.
As of now, the only medications are for pain relief. Obstruction does not go away with drugs.
Pyelopasty is an excellent option, and depending on local anatomy can give success results in excess of 90%. You need not go for robotic pyeloplasty. Laparoscopy gives equally good results and should be available easily at most major urban centres.
Hope I have been able to help you.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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