DAY 39 - MONDAY, MAY 19, 2008

Well we had hoped to have better news, but we know more today than we knew yesterday. Andrew's surgery didn't end up the way we had hoped it would. Initially the surgery was to occur in two phases. The first phase was to conduct a test on both ureters leading from the the bladder to the kidneys using a very thin wire. Under a fluoroscope, the wire will be visible as it is passed from the bladder through the ureter and into the kidney. The wire is to help determine where exactly the location of any constriction or blockage. If the wire was not able to pass all of the way through, the location of any blockage can then be found. The next phase was to repair any blockage or restriction that was found. Andrew's urologist conducted the surgery and in the beginning everything went well. We were able to determine that the right ureter and kidney were functioning very well. The urologist was able to guide the wire all of the way through. However the ureter is attached to the kidney in a slightly different place than where it normally should. Where it is located the ureter kind of curves as it enters into the kidney, which causes a slight bend in the ureter. A normal ureter would usually enter straight into the kidney. The curve in the ureter causes a restriction which reduces the amount of urine that can flow from the kidney to his bladder. We also learned that the perincum (kidney tissue which does all of the filtering function) in his right kidney continues to function very well and the urologist feels that for the short term he may not need surgery. She wants to watch his kidney over time and the ureter may correct itself as he grows larger and gets older.

As for Andrew's left kidney, the urologist was not able to guide the wire completely through his left ureter. She feels that there is a very tiny opening through it, but the wire was just too big to fit through. So without being able to see how the wire passes completely through the ureter, she cannot tell where exactly the blockage is located or how the ureter enters into the kidney. This in turn stops us in our tracks to continue with any repairs. To repair the kidney the ureter would need to be severed where it attaches to the kidney and reattached at another location. But because the location of the blockage in the upper part of the ureter cannot be determined and how the ureter enters the kidney is unknown, the urologist would have to do the repair blindly. She was not willing to risk doing more harm to Andrew until she was able to know where everything was. Unfortunately the radiology equipment at Summerlin Hospital wasn't capable of showing as fine a detail as they needed. Normally the wire method works fine in detecting blockages and the path the ureter takes, but Andrew's case seems to be more difficult. 

So as it stands now, the urologist has suggested that an additional test and second surgery be performed at Sunrise Hospital where they have an MRI that can provide a higher level of resolution to locate the blockage. So the nephrostomy tube draining his left kidney was left in place and he has been returned to the NICU for recovery. Before the surgery they removed the IV in his head, but instead added IVs into both feet and left hand. This was done to provide fluids and medication during the surgery. Also he was put back on a ventilator during the surgery. But because they had a difficult time inserting the ventilation tube into his trachea (stemming from the TEF surgery) they plan on leaving him on the ventilator until tomorrow. This will allow the surgeon that did the TEF surgery time to examine him before they remove it. The plan for now is to let him recover from the surgery and then have him discharged from the hospital as soon he is able. We hope that this can occur in a week or so. However he will still have the nephrostomy tube in place when he comes home. We then can schedule a time when the MRI and the second surgery can take place at Sunrise Hospital.

Before today we could see the end in sight, but now it looks like it will take a bit longer. So this set back lets us know that it won't be as easy for Andrew to overcome this as we had hoped. This means that he will have more tests, more surgeries, and additional stays in the hospital. But at least we will be able to bring him home for a while.