Incomplete answers

Although the specialist doctors met today, they will not make any decisions until a larger meeting Friday. For now, the summary is this: Before too long, Loki will need a pyeloplasty, the reconstructive surgery that I mentioned previously. The remaining questions are (1) whether to perform another surgery for a temporary solution that will allow the pyeloplasty to be delayed, and (2) when to do the surgery/surgeries.

You may recall that the urinary output of Loki’s kidney (the ureter) is blocked at the ureteropelvic junction. The urologist (specialist of the urinary tract) does not think it is an obstruction exactly, but that part of the ureter – which is a tube-shaped muscle that pushes urine down – is not working. In a pyeloplasty, the bad part is removed and the remainder is reconnected to the kidney. He was not at all worried about the surgery directly; he is confident of its success. The concerns revolve around the impact of deep anesthetics on Loki’s weak lungs, as he’ll need to be out for 2 to 3 hours. Even once the surgery is done, a different catheter (drainage tube) will be inserted, and not removed until the doctors are 100% sure that everything is working. We could take him home with this catheter still in place, if he has recovered in all other ways.

An option is to perform a cutaneous pyelostomy in order to allow more time for Loki to strengthen before the major surgery. Compared to the pyeloplasty, this is not as invasive or intense. This sounds like a stronger version of his current nephrostomy tube. With a cutaneous pyelostomy, the ureter is sent to the skin, and urine will just drain out of Loki’s side without a tube. Strange! But whatever works…

Regardless, these will likely be done in San Francisco.