Reconstructive surgery saves patient’s kidney
When Linda Nguyen walked into the lobby of the Lester and Sue Smith Urology Clinic, she was emotionally overwhelmed and desperate for help. After facing complications from a previous kidney stone surgery that left her with a nephrostomy tube, she hoped Dr. Wesley Mayer could provide the relief and answers she needed.
Her ordeal began when a routine visit to her primary care provider revealed a urinary tract infection through a urine test. After several months of recurring infections treated with oral antibiotics, the bacteria became resistant. As a result, she required a four-week course of long-term antibiotics administered at home through a PICC line.
A CT scan revealed a kidney stone approximately 4 centimeters in size in Nguyen’s right kidney, which would require surgical removal. Unfortunately, the procedure led to complications, resulting in scarring that obstructed the ureter – the tube that carries urine away from the kidney to the bladder. As a result, urine could no longer flow properly, and Nguyen was discharged from the hospital with a nephrostomy tube in place. She would need to consult with a surgeon specializing in urologic reconstruction.
“It felt surreal,” Nguyen recalled. “Like I was having an out-of-body experience. I understood what was being said to me, but I kept thinking, is this really happening? I had a large tube in my back that drained urine into a bag strapped to my thigh, which made sleeping difficult. I didn’t know how long I could handle it — mentally or physically.”
In addition to managing the daily task of emptying her urine bag and recording the drainage output, Nguyen was still adapting to life with a nephrostomy tube. This included covering the site during showers to prevent moisture exposure, carrying extra medical supplies and clothing in case of leakage, and relying on her husband to change the dressing. The experience was life-altering — one she says will stay with her forever.
From her very first consultation with Mayer, it was clear things would be different. Communication with Mayer’s staff exceeded her expectations, and she was able to schedule an appointment almost immediately after her referral. What impressed her most was the attentiveness Mayer showed — personally escorting her from the waiting area to the exam room and carefully listening and writing down the details of her health history.
Mayer took time to thoroughly explain the different reconstructive surgery options available. Initially, Nguyen was interested in an autotransplant, a procedure in which the kidney is removed, repaired and reimplanted in a different location within the body. Her second option, which she also had been considering, was total nephrectomy, the complete removal of the kidney.
After months of diagnostic testing and consultations with Mayer and the Baylor St. Luke’s transplant team, it was determined that an autotransplant was not the best option for Nguyen. Although the transplant surgeon remained optimistic, he explained that right kidney transplants are rare due to the body’s vascular anatomy. The complexity of the situation began to weigh on Nguyen; still, she understood that the process took time and didn’t want to rush into a decision that could affect her long-term outcomes.
“I’m not the one doing the surgery,” Nguyen said. “I have the easy part. All you have to do is tell me when to show up, I go to sleep, wake up, and it’s all done. When I talked to Dr. Mayer, I told him to give me realistic options, and no need to sugarcoat anything — be very straightforward with me.”
In Nguyen’s mind, a nephrectomy — removal of the kidney — was a very real option given the severity of her ureteral scarring along with the discovery of multiple veins and arteries branching from her right kidney. She expressed this to Mayer, who explained that while kidney removal might seem attractive in its simplicity, it could have long-term consequences on her kidney function and ultimately affect her overall quality of life.
The team decided on an ureterocalicostomy in hopes of preserving her existing kidney. A ureterocalicostomy is a complex surgical procedure to reconstruct the urinary tract by connecting the ureter directly to a kidney calyx to relieve obstruction or stricture.
“Ms. Nguyen’s case was incredibly complex,” explained Mayer, associate professor in the Scott Department of Urology. “Her right kidney was completely blocked due to an injury during a previous surgery, and the usual ways to fix it weren’t possible. One option was to remove the kidney and reimplant it elsewhere — an autotransplant. But that’s much harder on the right side, especially since she had extra blood vessels and severe scarring where the kidney connects to the urinary system. The other option, an ureterocalicostomy, meant carefully removing part of the kidney’s lower pole and directly attaching the ureter to one of the internal drainage chambers called a calyx. It’s a rare and technically demanding procedure, especially when done robotically, and even more challenging in a healthy kidney with thick tissue like hers. But it gave us a chance to save her kidney. It took a lot of planning and was a long surgery, but I’m so glad it worked. She deserved the best outcome.”
The surgery and recovery process were challenging. After seven hours in the operating room and a five-day hospitalization, Nguyen went home with a ureteral stent, nephrostomy tube, Foley catheter and a surgical JP drain, along with strict restrictions for six weeks. On May 19, the ureteral stent was finally removed — a welcomed birthday surprise — and shortly thereafter, studies confirmed that the surgery had been a success. A few weeks later, on June 12, the nephrostomy tube she had lived with for six months was removed. Although it would take several more weeks of monitoring symptoms, urine output, and continued diagnostic testing to ensure that her kidney was functioning and draining on its own, the surgery proved to be a success.
“There are good doctors out there,” Nguyen said. “There are a lot of good doctors, but he is an amazing doctor — and there aren’t a lot of those. He set the bar so high. I even commented to Dr. Mayer that he can’t ever get rid of me as a patient. Dr. Mayer possesses a wealth of knowledge, he’s compassionate, and his communication makes the biggest difference. It builds trust. He was able to salvage my kidney so I can live many more healthy years without worry. I really do owe him my life. My level of appreciation and unwavering gratitude for Dr. Mayer and his entire team is beyond any words or actions that I can describe. I can only hope that he truly understands the difference he makes and how truly blessed his patients are to have him as a physician.”
By Alexandria Brown, senior marketing associate in the Scott Department of Urology
