UPJ obstruction in a 12 yr. old boy

[jenac]

Ok guys- once again I bow to the experts here. As a nurse- I trust another nurse's insight .....so please allow me to pick your brains.

My 12 yr. old had N/V x 6 hrs, followed by stark hematurea. No fever, no prior c/o pain or burning or discomfort. ER dx him with pylonephritis- WBCs were >21.2 (ALL his labs were whacked out)He was admitted for IV Amoxicillan. IVP showed an possible stenosis of the UPJ with extreme swelling of the kidney (from the infection and the delayed release of the urine, right?), Urologist felt is was a partial obstruction, possibly there since birth-but presenting no problems untill now. No sweat- I get that.

But, being the nosey mom I am (I know, I know), I got a copy of the C&S which showed E.Coli as the causative bacteria. My question is, is this normal (Well-normal, yet infrequent) in the higher area of the GU system? I would expect this in a girl, or even in the bladder for that matter- but I'm surprised it was in the kidney. Am I missing something here? Probaly the obvious- but I still find it curious that this was the bug present. Any insight?

He has a voiding Cystourethragram and Lasix Renogram scheduled tommorrow, with follow-up at the Urologists on Monday. He's talking surgery to correct the UBJ problem- I'm curious as to the technique they use. Do they do that via scope, or is it an actual incision? Anyone have experience with that and care to share?

As I said- we are doing the follow-up on Monday, and I will be asking lots of the Urologist. I work Geriatrics-so PEDS is a little out of my league. Any input here would put my mind at ease-and would be greatly appreciated.

Thanks for any input you may have!