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What is extrarenal pelvis?

Q: My daughter is three years old. She is suffering from urine infection and high temperature (40°C). She underwent a renal ultrasound scan. The scan imaging showed an extrarenal pelvis on the left side. The doctors have prescribed her to undergo DMSA and DIC scans. What is extrarenal pelvis? Does it mean that the left kidney has two pelvis, one internal and one external? Would it affect the normal functioning of the kidney? I also wanted to know if an operation is required to correct it. Should it be a matter of concern for the normal growth and health of my daughter?

A:The drainage tube of urine starts from each kidney. Its proximal end is like a receptacle called pelvis, which is usually inside the kidney and tapers to form the ureter - a long tube which takes urine to the bladder. Some individuals may have a large pelvis, a part of which is extrarenal, i.e. lies outside the kidney. If there is no obstruction, it may not need any correction. A large pelvis might mean some stasis of urine for a longer time in the pelvis, which might predispose occasionally to infections, especially if associated with reflux. For this, you have been asked to get a micturating cystography and DMSA scan. It might be a good idea to get a DTPA scan to rule out any obstruction at pelvis–urethral junction. Unless there is grade V reflux or an obstruction, surgery is not required. It there is recurrent UTI and lower grades of reflux, she might need long-term small doses of antibiotic prophylaxis till the age of 10 years. Mostly there should not be any concern for normal growth or health, especially if the DTPA and DMSA scans are normal and do not reveal a kidney scar.

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