Urology care uncovers a surprising culprit in Brendan’s mystery illness

Brendan Grenier doesn’t remember the first time he met Dr. Joseph Borer, a surgeon in the Department of Urology at Boston Children’s Hospital, but his parents do. Born with an unrelated urologic problem, he required a minor surgery. “We wanted the best doctor, and we found that in Dr. Borer,” remembers his mom, Julie. “When we met him, he spoke directly to Brendan, picking him up and explaining his issue, even though Brendan was only a year old at the time. We could see Brendan was very much at ease with Dr. Borer.”

With the surgery a success, Julie and her husband, Mike, vowed they would return to Boston Children’s if Brendan ever needed care in the future. More than a decade later, they found themselves faced with that very concern.

An isolating time

In his first few years, Brendan seemed healthy. Gradually, he began to feel sick, with each year bringing more days of nausea and exhaustion. He pushed himself to stay active and play sports, but it started to become more difficult. Over time, he developed motion sickness so severe that he struggled during the 5-minute drive to school. He began losing weight and had difficulty eating, especially filling, bulky foods. Brendan’s immune system didn’t seem to be working well. He kept getting viral illnesses and had two bouts of strep throat that he couldn’t shake. Eventually, Brendan stopped playing sports because he felt so ill.

Despite his doctors’ best efforts, the cause remained a mystery — all they could determine was that Brendan had chronic nausea and felt anxious.

“As a parent, it’s hard to drown out the noise of everyone telling you your child is fine when you know they’re not,” says Julie, who tried to boost Brendan’s immune system and let him rest when he felt especially sick. “It was very isolating at times, feeling so misunderstood.” Brendan’s illness affected his older brother, too. “I had to say no to sleepovers and parties during cold and flu season. I always worried he would bring home a virus that would be difficult for Brendan to fight.”

A surprising culprit

Eventually, blood and tissue appeared in Brendan’s urine — a clear sign that something was very wrong. Indeed, ultrasound imaging revealed a surprising culprit: a distended bladder and hydronephrosis, or urine backup into the kidneys. The cause was still unknown, but the Greniers had a feeling this would explain Brendan’s years of illness. When their pediatrician advised them to consult with a urologist right away, they knew just who would be able to help them. They made good on their earlier promise and contacted Dr. Borer for a diagnosis

At Boston Children’s, a more specific test, called a voiding cystourethrogram, pinpointed the problem. Brendan had two massive diverticula in his bladder. These pouch-like sacs, each one larger than his actual bladder when full, protruded through the bladder wall. They would fill with urine, causing him to retain much larger volumes than normal. As his bladder emptied, the diverticula would drain and refill the bladder. This caused unhealthy thickening of the bladder wall due to constantly being full, leading to chronic infections.

The Greniers were shocked. For all of his illness, Brendan never experienced typical urinary symptoms like accidents, difficulty urinating, or infections. Dr. Borer recommended surgery as soon as possible.

Finally, answers

While the Greniers were relieved to finally have answers, Brendan was understandably nervous about the prospect of surgery. “Dr. Borer asked him to write down all of his concerns. Then he handed Brendan his business card and told him to call him,” says Julie. During that call, Dr. Borer explained the procedure in terms Brendan could understand, patiently discussed each of his concerns, and promised to do what he could to address his greatest worry, nausea after surgery.

On the day of the surgery, the family got another surprise. Dr. Borer uncovered a blockage of tissue in Brendan’s urethra, which caused pressure up above in his bladder and allowed the diverticula to form. It was also discovered that the ureters were inside the diverticula, which required reimplantation. In total, he performed five procedures on Brendan that day, to remove the blockage and diverticula and re-implant both of his ureters into the bladder.

Although the procedure took much longer than expected, Julie and Mike felt validated. “He told us that anyone with a bladder like Brendan’s would be incredibly sick,” Julie remembers. “We knew that his body had been fighting something and finally felt understood.”

Moving forward

Brendan’s recovery was a long one. “We relied a lot on Dr. Borer, nurse practitioner Lauren Cullen, and the rest the team for reassurance,” says Julie. The family still travels to Boston Children’s from their home in Connecticut for annual follow-up tests.

But Brendan, now 13, believes that the surgery was worth it. He and his parents are still noticing changes: He can ride in a car again without feeling ill and he eats whatever he wants. His energy is lighter, too, as if a weight has been lifted. Now that his stamina has increased, he’s back to playing his favorite sports — even serving as catcher on his baseball team — and has achieved high honors in school. And, prior to the COVID-19 pandemic, both Grenier boys were finally able to attend social events again. “Brendan took a step back after surgery,” says his mom. “But now he’s moved so far forward. It’s changed the whole dynamic of our family for the better.”

Learn more about the Department of Urology.