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Is surgery necessary for hydronephrosis?

Q: My 7 years old nephew has been diagnosed with hydronephrosis. Three months ago he suddenly started having back pain and vomiting and this is when the problem was discovered. We have consulted many urologists and surgeons and they have all suggested surgery. The renal test shows left kidney is functioning 30% and right 70%. We have also done the IVP test. The doctor is insisting that we have to get an MCU test done to check for reflux. Is it necessary to do surgery? Is the MCU test necessary (it seems to be an uncomfortable test)? The sonography indicated PUJ obstruction. Please advise.

A:Reflux is usually a congenital condition when urine goes back up the wrong way from the bladder towards the kidney, while the bladder is emptying. Though it can be asymptomatic, but depending upon the severity of the reflux disease, many times it results in recurrent urinary tract infection and injury to kidneys. Sometimes, children with reflux kidney disease may have other abnormalities within the kidney or lower down- for example, impaired development of kidneys or narrowing or blockage of the urinary tract resulting in ‘hydronephrosis’ (expansion of the urinary drainage system). Your nephew has undergone ‘Renal scan’ study and Intravenous pyelogram (IVP), which evaluates the size, position, shape, and filtering function of each kidney. In addition, he would need to undergo ‘micturating cystourethrogram’ (MCU), a standard and a safe procedure to diagnose and study the grade/severity of the reflux disease, which would guide further treatment including surgical correction of the reflux. It involves insertion of catheter into the bladder followed by injection of contrast liquid through the catheter into the bladder that will show up on X-ray pictures taken during urination effectively diagnosing presence of reflux disease. Timely surgical intervention as advised by the Urologist can help prevent further episodes of kidney infection and further damage to the kidneys.

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