Pyeloplasty is a surgical procedure performed to correct a condition known as ureteropelvic junction (UPJ) obstruction, where there is a blockage at the junction where the kidney meets the ureter (the tube that carries urine from the kidney to the bladder). This obstruction can cause impaired urine flow, leading to kidney damage, pain, and infections.
Indications for Pyeloplasty
Ureteropelvic Junction (UPJ) Obstruction: The primary indication for pyeloplasty is UPJ obstruction, which can be congenital (present at birth) or acquired due to conditions such as kidney stones, trauma, or previous surgery.
Symptoms: Patients may experience symptoms like flank pain, recurrent urinary tract infections, kidney stones, or hydronephrosis (swelling of the kidney due to urine buildup).
Deteriorating Kidney Function: Evidence of decreasing kidney function or progressive hydronephrosis on imaging studies.
Procedure Overview
1. Preoperative Preparation
Evaluation: Patients undergo a thorough evaluation, including imaging studies such as ultrasound, CT scan, MRI, or a nuclear renal scan to assess the degree of obstruction and kidney function.
Fasting: Patients are typically instructed to fast for several hours before the procedure.
Medications: Instructions are given regarding medications, particularly if the patient is taking blood thinners or other medications that need to be adjusted before surgery.
2. Anesthesia
Pyeloplasty is performed under general anesthesia, ensuring the patient is unconscious and pain-free during the surgery.
3. Surgical Techniques
Open Pyeloplasty: Traditional approach involving a large incision in the flank or abdomen to access the kidney and ureter. This approach is often reserved for complex cases or when other techniques are not feasible.
Laparoscopic Pyeloplasty: Minimally invasive technique using small incisions and a laparoscope (a camera) to guide the surgery. It offers quicker recovery and less postoperative pain.
Robot-Assisted Laparoscopic Pyeloplasty: An advanced minimally invasive technique using robotic instruments controlled by the surgeon, providing greater precision, especially beneficial for delicate reconstructive work.
3. Procedure Steps
Incision: Depending on the chosen technique, either a large or several small incisions are made.
Dissection: The surgeon identifies and exposes the UPJ obstruction.
Excision and Reconstruction: The narrowed or obstructed segment is excised. The healthy ends of the renal pelvis and ureter are then sutured together to create a wide, unobstructed junction.
Stent Placement: A temporary ureteral stent is often placed to ensure urine flow during healing and prevent postoperative obstruction.
Advantages of Minimally Invasive Techniques
Reduced Pain: Smaller incisions lead to less postoperative pain.
Shorter Hospital Stay: Faster recovery times and shorter hospital stays.
Quicker Return to Activities: Patients can return to normal activities sooner compared to open surgery.
Pyeloplasty is an effective treatment for UPJ obstruction, significantly improving symptoms and preserving kidney function. Advances in minimally invasive and robotic-assisted techniques have enhanced the safety and recovery process for patients undergoing this surgery.
