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    Suggest treatment for hydronephrosis on the left kidney

Posted on Mon, 7 Aug 2017 in Kidney Conditions
Question: Good Morning! I am scheduled for surgery by a urologist due to hydronephrosis of my left kidney, I believe due to scar tissue from previous radiation and chemo from cervical cancer. I just wonder if ureteroscopy is the right procedure if there is scar tissue blockage of the ureter?
Answered by Dr. Prof. Kunal Saha 2 hours later
Brief Answer:
A urogram needs to be done first.

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone carefully through your query and understand your concerns. Hydronephrosis can only be caused if there is a blockage somewhere. I am not certain that scar tissue from previous radiation would be sufficient to cause a blockage. Nevertheless, the exact location of the block needs to be identified. A constrast aided urogram would be the simplest and best way to identify the location. If that does not help a ureteroscopy might be needed.

Let me know if I could help further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Prof. Kunal Saha 21 minutes later
Thank you, Dr. Saha,

I was considered "in remission" from cancer in 1989, and one issue I should have mentioned earlier is that after a radical hysterectomy (due to the cervical cancer), an additional tumor was found wrapped around my ureter to my left kidney. I went on to have radiation as well as two rounds of chemo after that. In the years since 1989, I have had a nephrostomy tube placed two different times, with the last time being in, I believe 1996. Although radiological tests were done at both times, I do not know, or do not remember being informed of a blockage other than possible scar tissue. When cleared of cancer in 1989, I was told that there was only scar tissue where the tumor had been. Since the previous nephrostomy was placed and subsequently removed shortly thereafter, I have not had any pain for many years until just recently. When I went to visit with the urologist for the surgery mentioned above, he asked about the state of my left kidney, and I gave the only response I knew of, which is that I was told it was no longer functioning. At that point, he told me that he needed to know exactly what amount of function or dysfunction I had, so that he could help. An ultrasound was ordered, and that was when he found the hydronephrosis of the left kidney. He mentioned that it was likely long-term damage, but since there is pain, he sent me for a CT scan with contrast. He mentioned putting in a stent, but in my research, I see that this is something that would likely need to be replaced every three months, so not the best option either, unless this could be done nonsurgically. Do you feel that those tests mentioned above would yield enough information to go through with ureteroscopy and possibly clear a scar-tissue type blockage? He did mention possible kidney stone(s) at one point, but he has not confirmed that to me. I guess I'm putting you on the spot a bit, but I really would like to be sure that if I go into surgery for the ureterscopy, this could possibly solve my problem without yet another surgery this year. I really appreciate your advice. Thank you very much! XXXX
Answered by Dr. Prof. Kunal Saha 3 hours later
Brief Answer:
Further testing not required

Detailed Answer:
Thanks for writing back. I do not suppose that CT scan would be helpful. Renal stones are a valid possibility to consider. No other investigation is likely to help.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Prof. Kunal Saha

General & Family Physician

Practicing since :1954

Answered : 4438 Questions


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