This one's long and "drawn out"

****UPDATE****: Her surgery is scheduled for January 5th and mine for January 12th.  Please pray for NO MORE INFECTIONS between now and that date that seems so far away even though it really isn't.

So we just got back from the urologist and here's what's going on:

Confusing isn't it?  Let's see if I can explain the picture above.  It's Dr. Smith's drawing of what the images from yesterday showed. 

First of all the big balloon looking structure is her bladder which he said is large and that's a good thing for what she has.  The two bean-like things above it are her kidneys.  The right one (shown on the left) is the one with all the issues.  The left one is fairly normal and they aren't concerned with it.  Her right kidney functions at 29% and her left at 71%.  Something I learned today was that normal kidneys are 50/50 not 100/100.  When one lacks in function the other makes up for it and the two numbers should add up to 100.  So if you have a kidney removed then the one that's left should take over at 100%. 

The tubes leading from the kidneys to the bladder are called the ureters.  As you can see, she has three.  Dr. Smith says that her right kidney has a "dual exhaust".  The ureter that is not shaded has a ballooning section at the mouth of the bladder.  That is the ureterocele that we've been talking about.  It causes blockage and subsequently reflux of urine back up into the kidney (reflux is the shaded area).  The particular kind of ureterocele that Molly has is a "cecoureterocele".  In this kind of ureterocele the surgery that he's going to perform greatly reduces UTI's but she will still be more prone to bladder infections (not as much damage to kidneys like now) than "normal" kids and the likelihood will decrease as she gets older.

Here's an earlier post on the ureterocele itself.

Now, the surgery that Molly had in October of 2009 was to puncture the ureterocele to allow a better flow and decrease the amount of reflux.  It was done with a scope and no incisions were made.  This next surgery she'll have is to remove the cecoureterocele altogether and reroute her good ureter (the shaded one) to allow for a more normal functioning urinary tract.  The horizontal line in the picture above shows the incision.  He said it would be slightly lower than where the incision is for a c-section and they try to make it in the skin fold that babies have just above the pelvic bone.

In the picture below he was showing us how they would go in a construct a tunnel through which to reroute the remaining ureter.  Normally it fits between the layers of the bladder wall but since hers didn't grow that way he'll make a tunnel instead and then put the opening where it's supposed to be.  The scalloped portion that looks like it has an eye in it...that's him removing the cecoureterocele.  The "eye" is the incision that he made in the ureterocele back in October 2009.  At the end of the procedure he'll add an interior/exterior stint to keep the ureter open and prevent closure from swelling while things heal.  This will drain outside of her body into a diaper for about a week to allow for proper healing and then will be removed.

Best case scenario: surgery is successful, she never has another UTI or other kind of bladder infection.

Most expected outcome: surgery is successful, may have subsequent bladder infections but with less involvement of the kidneys, may have slight urinary incontinence.

Worst case scenario: surgery can be successful but chronic UTI's could cause a need for a second surgery to remove the entire kidney.  He said he's seen one case of this...very rare.

What we do now...

We're waiting for a call from his surgery scheduler.  The surgery is not urgent enough to require immediate attention but he does want it complete within the next 8 weeks.  The ER for the surgery is booked for 3.5 hours but he expects it to take less time than that.  She will spend anywhere from 1 to 5 days in the hospital.  The average is 3.  It will take anywhere from 7-14 days to recover at home before she can go back to school etc.

So that's what we learned today.  I'm anxious to get both my foot surgery and Molly's surgery on the calendar so we can get things all figured out.  Patience, patience.  Thank you again for your prayers through all of this...the end is in sight!