Slate’s Medical Examiner column recently described a new procedure used to treat one of my two bladder conditions. For some reason, the article fails to mention the disease’s name, which is vesicoureteral reflux:
“The problem prevents the muscular wall of the bladder from acting as a one-way valve when the ureters (tubes) carry urine from the kidneys into the bladder. If the valve malfunctions, then infected urine can get into the kidney, potentially leading to kidney damage, loss of kidney function, and chronic high blood pressure.”
As far as congenital conditions go, this isn’t terribly rare. Mine was discovered after a bout of renal infection when I was three years old, and I was started on a nightly antibiotic, which I took for years.
“Long-term antibiotics can suppress bacterial growth, but the underlying condition isn’t cured, just treated, and the risk of repeat infection is high if treatment is briefly neglected. Extended treatment also may encourage bacteria that cause infections to become resistant to antibiotics. The other traditional treatment is open abdominal surgery on the bladder, a very delicate procedure that requires a skilled urologist and often extended postoperative hospital care.”
Yup. When I was six, I had my right ureter disconnected from and subsequently reimplanted into my bladder. While he was in there, the surgeon also found a mysterious third ureter which didn’t actually extend up to the kidney, but was just sort of coiled into my bladder wall. I find that pretty interesting; for whatever reason, the formation of my fetal urinary structures was fuxored enough that it grew not only malformed parts, but extra parts too. Nice job, Ma. In any case, I wouldn’t classify the surgery as one that required ‘extended postoperative care’. I was in the hospital for four days, but this was in 1989; I bet kids who have the operation now are only in for a day or two.
“Now there’s a third option: In a recent paper in the journal Pediatrics, Drs. Richard Yu and David Roth of the Baylor College of Medicine describe successfully treating children by plumping up the tissue surrounding the ureter at the point it enters the bladder. They passed a cystoscope (a tiny instrument that allowed them to look and work inside the bladder) through the urethra of the anesthetized patient, identifying the point where the poorly functioning ureter entered the bladder, and injecting a thick gel just below the surface to plump up the region around the too-open mouth of the ureter to make it into an efficient one-way valve. The procedure, which doesn’t require hospital admission and takes about 15 minutes, was performed on 120 children between 6 months and 15 years of age. It was 90 percent successful after one (or occasionally two) treatments, with no significant complications (two kids briefly had flank pain).”
Hm. I wonder what the longevity of this treatment will prove to be. As for me, by the time I had the operation my right kidney was already pretty well fried, and has remained a small mass of junk ever since. Happily, though, it stopped getting worse, and despite having many bladder infections since then, none of them have traveled up to the kidney.
I wish good fortune to my young cohorts who are undergoing this new procedure, but hope that parents and physicians don’t shy away from the traditional surgery, since the anatomical correction generally lasts forever. Sometimes more invasive is better, in my opinion. When you’re dealing with kidneys it’s best not to leave anything to chance. Plus, the scar it leaves behind is rather fantastic.