Overview of Pyeloplasty Surgery:

What is Pyeloplasty?

Pyeloplasty is a surgical procedure that corrects a narrowing or blockage at the ureteropelvic junction (UPJ)/ Pelviureteric junction (PUJ). This junction, where the ureter meets the kidney's collecting system (the renal pelvis), is crucial for proper urine flow. This obstructed PUJ can cause urine to go in the reverse direction i.e. up into the kidney, leading to various problems.

Why is Pyeloplasty Important?

A blocked UPJ can have serious consequences if left untreated. These include:

• Kidney damage: Backflow of urine can damage the delicate structures within the kidney, potentially leading to decreased function or even failure.
• Body pain: The kidney can become inflamed and tender, causing flank or abdominal pain.
• Infections: Urine stagnation increases the risk of kidney infections.
• High blood pressure: Chronic kidney problems can contribute to increased blood pressure.

When to see a doctor for treatment?

Pyeloplasty is typically recommended for individuals experiencing symptoms related to a blocked UPJ and/or if kidney function is affected, such as:

• Flank pain (one side of) or lower belly pain
• Blood in the urine
• Frequent urinary tract infections
• High blood pressure
• Decreased kidney function

Types of Pyeloplasty Surgery:

There are three main approaches to pyeloplasty:

• Open Surgery: A traditional incision in the abdomen or flank allows direct access to the UPJ for repair or reconstruction.
• Laparoscopic Surgery: Minimally invasive surgery using small incisions and laparoscopic instruments to perform the procedure.
• Robotic-Assisted Laparoscopic Surgery: Similar to laparoscopic surgery, but with the added precision and dexterity of robotic arms controlled by the surgeon.

The choice of surgery depends on various factors like the severity of the blockage, patient anatomy, and surgeon's expertise.

Before Pyeloplasty:

• Preoperative tests like blood work, scans (CT scan or MRI), and a kidney (renal) scan will be conducted to assess the UPJ and overall health.
• Discuss any medications or allergies with the doctor.
• Stop smoking and avoid alcohol for optimal healing.

After Pyeloplasty:

• Recovery typically involves a hospital stay for 1-3 days.
• A drainage tube may be placed to drain excess fluid.
• A ureteral stent will be inserted to keep the ureter open while it heals.
• Pain medication will be provided as needed.
• Follow-up sessions with expert urologists are crucial to monitor progress and to remove the stent.

Post-Surgery Care:

• Maintain a healthy lifestyle with a balanced diet, regular exercise, and adequate hydration
• Avoid strenuous activities until fully recovered (could take up to two weeks.)
• Report any concerns to your urology doctor promptly

Pyeloplasty is a safe and effective surgery with high success rates in improving urine drainage, reducing pain, and preserving kidney function. If you or your family members’ experience any symptoms suggestive of a blocked UPJ, consult our best urologists at NU Hospitals, Bangalore promptly to discuss potential treatment options.

By understanding the importance of pyeloplasty surgery and its role in maintaining kidney health, you can make informed decisions to get rid of urine problems and overall kidney-bladder issues.

FAQs:

Could we elaborate the do’s and don’ts after this surgery?

You can have a regular diet, once you are able to tolerate it orally. Sometimes, especially infants will have swelling of the tummy (abdomen) and this subsides in a day or two, till then IV fluids would be continued. The urethral catheter is usually removed on the 3rd day morning after surgery. And you will be allowed to go home later that evening with a ureteric stent (not visible outside the body), if you are doing well.

Drain tube or nephrostomy tube, if placed, would be removed at appropriate times based on the clinical situation. With ureteric stent inside, you may experience urgency, frequency, burning urination, mild blood-tinged urine and flank pain for a minute or so when you are passing urine. These are expected things, but if you have severe pain or high-grade fever, do contact your doctor. You will need to repeat urine culture 2 weeks after surgery. Based on the report, ureteric stent removal would be planned, if required under cover of appropriate antibiotics based on sensitivity.

What are the possible complications that can arise if this condition is left untreated?

If left untreated, PUJ obstruction can lead to progressive loss of kidney function, kidney stones or infection.

What is the follow up after stent removal?

Kidney ultra­sound is obtained 3 months after pyeloplasty to ensure that the hydronephrosis is reduced or at least remaining stable. A nuclear scan (DTPA / EC) may be obtained 1 year after the pyeloplasty to provide a relative assess­ment of the overall kidney function and drainage pattern.

When do you say surgery is successful?

Improvement in hydronephrosis (enlargement of the renal pelvis) on ultrasound and stabilization or improvement in function on nuclear scan (DTPA/EC). If a patient had symptomatic presenta­tion, resolution of flank/abdominal pain or vomiting should also occur.

What are the other complications of surgery?

Less than 5% of patients may have a recurrence of narrowing at the PUJ requiring redo surgery. Urinary leakage from the area of surgery may require placement of the percutaneous drain. Other problems include wound infection and hernia which are very rare.