By Dr Dumpala Hari Prasada Rao
Consultant Urologist

Published on / 30 July 2022

Article Context

  1. Overview
  2. Procedure
  3. Benefits and Risks
  4. Care at Medicover
  5. Frequently Asked Questions

Overview

Pyeloplasty is a procedure that repairs blockage of the ureter where it exits the kidney. This condition is known as a ureteropelvic junction (UPJ) obstruction, and it causes poor and slow drainage of urine. Ureteropelvic junction obstruction is most common in children.

A blockage occurs when the area between the ureter and the kidney narrows. This problem can occur during the development of the kidney. Kidney damage can result from urine buildup and increased pressure in the kidney. Typically, this condition affects only one kidney. Some of the causes of blockage in adults and children are:

  • Abnormal blood vessel over the ureter.
  • Scar tissue
  • Infection
  • Kidney stones

UPJ obstruction can result in flank and abdominal pain, kidney stones, infection, hematuria, hypertension and damage to the kidney function.

Indications

  • Presence of clinical symptoms of ureteropelvic junction (UPJ) obstruction.
  • Progressive impairment of renal function.
  • Development of one-sided urinary tract calculi or infection or hypertension related to obstruction.

Procedure

Before the Procedure

  • Your Urologist will examine urine production and its output to diagnose the condition accurately.
  • Blood samples may be collected to know about your general health. The urine samples consisting of blood urea nitrogen and also creatinine tests will determine how well the kidney filters the blood.
  • In the past, an intravenous pyelogram (IVP) was frequently used to inject a dye into the blood. An X-ray test is taken to see how the kidneys expel the contrast dye from the blood. Your doctor can monitor how the parts of the kidney look as the dye passes through urine
  • A nuclear renal scan is used to know how the kidney works and to find out the extent of blockage. In this, radioactive material is used instead of dye.
  • CT scans are used to know the cause of severe pain. If an obstructed kidney is the origin of the pain, a CT scan can easily reveal it. The kidneys, ureters, and bladder are also examined using magnetic resonance imaging (MRI). However, MRI is expensive and may not be used commonly.

During the Procedure

There are three possible ways the surgery may be done:

1) Open surgery- The surgeon's cut is typically 2 to 3 inches long and located just below the ribs. This operation typically takes a few hours and has a high success rate (95%).

During this procedure, the ureteropelvic junction is removed to create a wide opening, and the ureter is reconnected to the renal pelvis. This allows urine to drain rapidly. It also reduces both symptoms and the risk of infection. After surgery, the patient may need to stay in the hospital for a day or two. Drainage tubes can help with healing.

2) Laparoscopic surgery- General anaesthesia is used for laparoscopic pyeloplasty. The operation usually lasts three to four hours. To perform the operation, the abdomen is cut with three 1 cm incisions. Through these keyhole incisions, a camera and instruments are placed into the abdomen, allowing the surgeon to repair the blockage.

At the end of the surgery, a small tube called a ureteral stent is placed inside the ureter. This stent will be retained for four weeks before being removed from the hospital. A small drain will be left in your flank to drain any fluid from the kidney and pyeloplasty repair.

3) Robotic surgery- Several small incisions are made in the belly. The surgeon uses a computer to control the robotic arms, which move small tools underneath the skin to do the operation.

After the Procedure

  • Typically, patients recover quickly. The ureter may be swollen for some time during the postoperative period. Some people experience pain, and kidney drainage can also be poor, but it usually improves with time. The doctor uses ultrasound to check for hydronephrosis (swollen kidney) after a few weeks.
  • A drainage tube is sometimes left in place to help drain the kidney while it heals. The kidney's appearance will improve over time, but it will not appear normal.
  • Children can participate in many activities when the obstructed kidney responds favourably to treatment, and the other kidney is normal. Once the ureteropelvic junction obstruction is removed, it never reappears.

Benefits

The benefits of pyeloplasty are:

  • It can protect the kidneys from damage.
  • It can help in the normal functioning of the kidneys.
  • It will reduce pain and future kidney infection.
  • It will improve the overall health of the child.

Risks

Although the pyeloplasty procedure is safe, there are risks and potential complications, as with any surgical procedure. The risks include:

  • Bleeding: Bleeding is usually minor.
  • Infection: To reduce the possibility of infection in the postoperative period, all patients are given antibiotics before proceeding with the operation.
  • Hernia: As the incision sites are carefully closed at the end of the surgery, hernias at incision sites are very rare.
  • Injury to tissues or organ: Although uncommon, injury to surrounding tissue and organs such as vascular structures, liver, pancreas, and gallbladder may necessitate additional surgery.
  • Conversion to open pyeloplasty: If the laparoscopic procedure proves too difficult, the procedure may be converted to an open operation. This results in a large standard incision and possibly a longer recovery period.
  • Failure to correct UPJ obstruction: Few patients may have a blockage due to recurrent scarring. In such cases, additional surgery may be required.

Care at Medicover

At Medicover Hospitals, we are supported by a team of highly skilled urologists with a proven track record of success with complex surgeries. We have round-the-clock doctors, laboratory, ICU, radiology, and 24*7 emergency medical services to ensure patients receive the best possible care on time. Our hospital is also equipped with the advanced diagnostic services and healthcare technologies to perform the pyeloplasty procedure with minimal risk while yielding the best results.

Frequently Asked Questions:

A diet high in fibre and water may help prevent constipation. It is critical to drink plenty of fluids (8-10 glasses per day).

It will take 10-14 days to recover fully from the procedure, and most people can return to normal activities after 2-4 weeks.

The procedure takes 1 to 2 hours. The blockage can be removed through keyhole surgery (laparoscopy) or through traditional open surgery.

You may experience a burning sensation and have blood in your urine. This is normal and will go away when the stent is removed during a subsequent visit.

Short tub baths or showers are fine 48 hours after surgery, wash with soap and water. Avoid swimming for 2 weeks after surgery.

There are various types of pyeloplasty depending on the surgical technique and incision patterns used. These include the Y-V, Inverted and Dismembered pyeloplasty techniques. The most common type of pyeloplasty is dismembered pyeloplasty (also known as Anderson-Hynes pyeloplasty).

The stent is removed a few weeks after surgery in the operating room. This is an outpatient procedure. Another tube, known as a drain, may be inserted around the kidney and ureter to drain extra fluid that may accumulate during and after surgery. When the drainage stops, the drain is removed.

Most patients undergo removal of the stent using only a topical anaesthetic placed in the urethra. Shortly, before the procedure, sterile lubrication containing a local anaesthetic (lidocaine) is introduced into the urethra.

A blockage may be present where the renal pelvis connects with the ureter. It carries urine from the kidneys to the bladder. This narrowing causes the kidney to swell, a condition called hydronephrosis.

Robotic pyeloplasty combines high-definition 3D magnification, robotic technology, and miniature instruments to improve accuracy when correcting a blockage in the renal pelvis.

References:

  • https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/laparoscopic-pyeloplasty
  • https://www.umms.org/childrens/health-services/pediatric-surgery-urology/diagnosis-conditions-treated/pyeloplasty-surgery
  • https://urology.ufl.edu/patient-care/robotic-laparoscopic-urologic-surgery/procedures/robotic-pyeloplasty/
  • https://www.urologyhealth.org/urology-a-z/u/ureteropelvic-junction-(upj)-obstruction