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Urology/Extrarenal pelvis

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QUESTION: I am a 60 year old woman. I just had an abdominal and suprapubic pelvic ultrasound. I had been experiencing severe nausea as well as intermittent right abdominal pain. I have collagenous colitis. the ultrasound was generally unremarkable. However, they found that the right kidney had an extra renal pelvis with slight fullness, but no significant abnormality. I have had numerous bladder infections over the years as well as a kidney infection. I have some pain, but no burning, after I urinate. I have no signs of infection as far as I know. I had a  urine culture recently. The results were negative.
I also have an 8mm thickening of the uterus that will be biopsied in 2 1/2 weeks. I only use small amounts of low-dose topical estrogen for senile vaginitis.I have had very minor spotting in the last few weeks.
Should I make an appointment with my urologist?

ANSWER: Harriet:

Might not be a bad idea to see the urologist.  There is a condition called UPJ obstruction that can cause intermittent flank pain and might appear as you've described.  To be sure, we sometimes order a diuretic renal nuclear scan.  If this reproduces the pain and shows a slower than normal excretion from the affected kidney, then we can reliably make the diagnosis.

With regards to your urine infections, most of the time these are due to less than optimal hygiene techniques.  Here is what we usually recommend:

After voiding, wipe only once going from the front to the back.
You can use toilet paper or a sterile baby wipe.
Wash your hands before wiping.

Avoid baths; take only showers.
Use a clean, liquid soap like Ivory, Dial, Eucerin, Neutrogena or any liquid baby soap.
Use clean washcloths. After washing, put them in a plastic bag to keep them extra clean.
When washing, wash your hands first, then take out the washclot, wet it, add the clean liquid soap and clean the bladder opening area first wiping front to back.  Rinse well and don't touch that area again.  You can then clean everything else.

Most of the time, these simple instructions really help with recurrent UTIs.  We also recommend some extra vitamin C.

---------- FOLLOW-UP ----------

QUESTION: I've read that an extra-renal pelvis may be an interesting anomaly however it usually is no cause for concern. Isn't it possible that  the concurrent nausea and flank pain could be coincidental to the condition and not signify an actual condition of UPJ obstruction?
Thank-you again

Answer
Harriet:

Yes, that's possible but since we know there is an extrarenal pelvis and that a UPJ obstruction might cause the symptoms you've had, it only makes sense to check it out and see if you have the UPJ or not.  If not, then we've proven forever that there is no relation.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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