![]() There were no complications, and in December, Jacobsen’s nep tube was removed for good. The two-and-a-half-hour procedure involved identifying the blockage and removing a roughly three-inch section of scar-choked ureter, shifting the bladder up, and connecting the bladder to the healthy ureter. Jacobsen quit smoking, and on Halloween 2019, Higuchi went to work on Jacobsen’s 104 th surgery. Higuchi had made his emotional-physical decision. She then said, “I’ve heard there’s a doctor here who could do away with my nephrostomy tube.” Choosing ureteral reconstruction In that UCHealth Urology Clinic exam room, Jacobsen told Higuchi a story that jibed with and augmented the one he had read in her medical record and seen in her scans. “But then you have the harder decision based on what you’re seeing and the objective inputs.” “I think all surgeons have an overwhelming feeling that they want to help the patient,” he said. ![]() He described it as being an “an emotional-physical decision.” Higuchi was faced with a tough call on whether to perform the surgery. “Walking around with bags and tubes hanging out of me just pulls me down as a person.” Pamela Jacobsen, left, and Stacy Grant at Mother’s High Tea Event at the McNichols building. At night you’ve got to be careful or you’ll pull the stitches out,” she said. Her nutrition was good, and she was only 49 – both positives. These were dangerous infections that a ureteral reconstruction could end. On the other hand, Higuchi saw that Jacobsen had been hospitalized more or less monthly for the last two years, often for multidrug-resistant infections from the nep tube. Weighing pros and cons for ureteral reconstruction Plus she was a smoker, which surgeons have long known can result in slower healing. That backup plan wouldn’t be an option for Jacobsen because previous surgeries had removed much of her small intestine. In typical cases, should Higuchi find that the surgically shortened ureter no longer quite reaches to the bladder, he can use a section of small intestine to fashion an extension to the ureter and anchor it to the bladder. There was a lot of scarring in her abdomen that introduced a high risk of bleeding. With a case such as Jacobsen’s, robotic surgery wasn’t an option. After ureteral reconstruction, Pamela Jacobsen is free of her nephrostomy tube. The smaller incisions generally mean much faster recovery times. It’s a painstaking procedure, but Higuchi and Flynn are skilled enough at it that they can perform it with minimally invasive da Vinci robotic surgery. Often, the surgeon must stretch or surgically alter the bladder to compensate for the shorter ureter. The operation involves identifying the section of ureter that’s blocked (a dye-sensing X-ray unit in the operating room helps with this), removing that section, and reconnecting the kidney to the bladder via the healthy ureter that remains. The surgery, should she be a candidate for it, would involve a ureteral reconstruction. Is ureteral reconstruction the right choiceīefore Jacobsen’s visit, Higuchi reviewed a long and winding medical history and looked over her many scans. Jacobsen sat in an exam room with Higuchi, a University of Colorado School of Medicine and UCHealth urologist and surgeon, less than two weeks later. They worked with patients with blockages of the ureter caused by scarring from cancer, kidney stones, and other causes. Physicians there handled cases similar to hers. Jacobsen should touch base with the UCHealth Urology Clinic – Anschutz Medical Campus, the nurse said. Then a nurse at a local community hospital, one who had once worked at UCHealth University of Colorado Hospital on the Anschutz Medical Campus (UCH), suggested otherwise. The answer was always the same: “Impossible. ![]() Jacobsen asked more than once whether there wasn’t a surgical fix. For two years, doctors told the Aurora resident she’d have that nep tube for the rest of her life. But rather than link kidney to bladder, the nep tube exited her back to connect the kidney to a bag she now had as a constant, unwelcome companion. ![]() The workaround had involved a nephrostomy tube, or “nep tube.” The nep tube, inserted through the lower back into the center of her kidney, mimicked the job of the ureter. Her abdominal surgeries had led to scarring, and the scarring had blocked a ureter, one of two nearly foot-long tubes that connect the kidneys to the bladder. One surgery, though, was a particular drag on her life. Other procedures targeted blood clots that increasingly formed in her veins. Many of them involved bowel-cancer treatments – and, later, fixes for damage done by those treatments. Pamela Jacobsen had undergone 103 surgeries. Pamela Jacobsen with granddaughter Honor Grace. ![]()
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