Pyeloplasty – for ureteropelvic junction obstruction

What is Pyeloplasty?

Pyeloplasty is a surgical procedure used to correct a ureteropelvic junction (UPJ) obstruction, which is a blockage at the area where the kidney connects to the ureter. This blockage prevents urine from draining properly into the bladder, causing it to back up into the kidney. This can lead to swelling of the kidney (hydronephrosis), infections, pain, or long-term kidney damage.

Anatomy Involved:

• Kidney: Filters waste from the blood and produces urine.
• Renal pelvis: A funnel-shaped area in the kidney that collects urine.
• Ureter: A tube that carries urine from the renal pelvis to the bladder.
• Ureteropelvic junction (UPJ): The connection point between the renal pelvis and the ureter.

Who Needs Pyeloplasty?

Congenital Causes (Present at Birth):

• About 1 in 1,500 babies are born with a UPJ obstruction.
• Often diagnosed through prenatal ultrasounds showing kidney swelling.
• Surgery may be required if the obstruction does not improve naturally by 12–18 months of age.

Acquired Causes (Develop Later):

• Older children or adults may develop UPJ obstructions due to:
  • Scar tissue
  • Kidney stones
  • Blood vessels compressing the ureter
  • Infections or tumors
  • Previous surgeries

Common Symptoms:

• Flank or abdominal pain
• Recurrent urinary tract infections (UTIs)
• Nausea or vomiting
• Hydronephrosis seen in imaging
• Reduced kidney function

Types of Pyeloplasty

1. Laparoscopic Pyeloplasty: Minimally invasive with small incisions; commonly used today.
2. Robotic-Assisted Pyeloplasty: Uses robotic instruments for greater precision.
3. Open Pyeloplasty: Involves a larger incision; used in more complex cases.
4. Endoscopic Pyeloplasty: Performed through the urethra using a scope; limited to select cases.

Preparation for Pyeloplasty

Before surgery, your healthcare provider will guide you to:

• Fast for at least 8 hours before the procedure.
• Stop taking certain medications, especially blood thinners.
• Undergo diagnostic tests like blood work, urine tests, and imaging.
• Arrange for someone to drive you home after surgery.

How Pyeloplasty is Performed

1. You will receive general anesthesia, so you’ll be asleep during surgery.
2. The surgeon makes one or more incisions near the kidney.
3. The blocked or narrowed section of the ureter is removed.
4. The ureter is reconnected to the renal pelvis to restore urine flow.
5. A stent (small tube) may be placed inside the ureter to help with healing.
6. The surgical site is closed with sutures or staples.

The procedure usually takes about 2 to 3 hours.

Post-Surgery Hospital Stay

• Patients usually stay in the hospital for 1 to 2 days.
• You may have a Foley catheter to drain urine temporarily.
• Pain is managed with oral or IV medications.
• Patients can usually eat and move around within a day after surgery.
• You’ll receive antibiotics to prevent infection if needed.

Risks and Complications

Like all surgeries, pyeloplasty has some risks:

• Infection at the surgical site or urinary tract
• Bleeding
• Leakage of urine from the reconnected site
• Scar tissue formation (which may cause a new blockage)
• Adverse reaction to anesthesia
• Rare chance of recurrence

Recovery and Outlook

• Recovery Time: About 2 to 4 weeks for laparoscopic and 4 to 6 weeks for open surgery.
• The stent is typically removed after 2 to 4 weeks in a separate outpatient procedure.
• Avoid heavy lifting or strenuous activities for several weeks.
• You’ll have follow-up imaging to check kidney function and ensure proper healing.

Long-term Outlook:

• Pyeloplasty has a success rate of over 95%.
• Most patients experience relief from symptoms and preservation of kidney function.

When to Call the Doctor

Seek medical attention if you notice:

• Fever over 100.4°F (38°C)
• Persistent or worsening pain
• Redness, swelling, or discharge from the incision
• Excessive blood in urine
• Difficulty urinating
• Signs of infection (chills, nausea, vomiting)

Frequently Asked Questions

Is pyeloplasty painful?
Some pain is expected but usually well-controlled with medications. Laparoscopic surgery results in less discomfort.

Can the condition return?
Recurrence is rare, especially when surgery is performed by experienced surgeons. Follow-up imaging helps detect any issues early.

Will it affect kidney function?
If treated promptly, the procedure can restore and preserve kidney function.

Can I resume normal activities?
Yes, but avoid strenuous activity for a few weeks. Most people return to work or school within a few weeks, depending on the surgical method used.