Pyeloplasty

Overview

Pyeloplasty is a surgical procedure designed to correct a Ureteropelvic Junction (UPJ) obstruction, a condition where urine flow from the kidney to the bladder is blocked. During the surgery, the surgeon removes the blockage to restore normal urine flow, preventing it from backing up into the kidney.

Urine is typically collected in the renal pelvis, a funnel-shaped section of the kidney, and then travels through the ureter to the bladder. The ureteropelvic junction is where the renal pelvis and ureter connect. When there’s an obstruction at this junction, it can lead to complications such as pain, infection, and kidney damage. Pyeloplasty is employed by doctors to resolve these issues and restore proper urine flow.

Reasons for undergoing the procedure

UPJ obstruction occurs in roughly 1 out of every 1,500 births. If your child is diagnosed with this condition and it doesn’t improve after 18 months, a pyeloplasty might be necessary.

Older children, teenagers, and adults can also develop UPJ obstructions. You may need a pyeloplasty if your kidney is blocked, preventing it from functioning properly and causing urine to back up, resulting in pain or infections. Your doctor may suspect a UPJ obstruction if hydronephrosis (kidney swelling) is detected on ultrasounds, Computed Tomography (CT) scans, or other imaging studies.

Pyeloplasty is typically a minimally invasive procedure. Surgeons can perform it using:

• Laparoscopically, having tiny skin incisions.
• Endoscopically, via the urethra, the tube that empties your urine out of your body.
• Open surgery, a larger incision must be made through the skin and surrounding tissues to access the kidney.

Risks

The dangers of pyeloplasty are the same as those of any operation. Among them are:

• Responses to the anesthesia.
• Infection.
• Blood clots.
• Bleeding with blood transfusion requirements.
• Injury to surrounding organs, such as your intestines or bladder, or blood vessels.
• Hernia.
• Scarring.
• Additional surgery may be necessary if the obstruction recurs due to scarring.
• Leakage of urine at the junction where your kidney connects to your ureter.

Before the procedure

Your doctor will provide specific instructions on how to prepare for your pyeloplasty. Following these guidelines carefully can help minimize potential issues. Here’s what you might be asked to do before the surgery:

• Fast for eight hours: Avoid eating or drinking anything for eight hours prior to your surgery.
• Medication: You may need to stop taking certain medications before the procedure, or you might be instructed to take them with only a sip of water.
• Transportation: If you will need to stay in the hospital overnight after the surgery, arrange for someone to drive you home.

Always follow your doctor’s specific instructions for the best outcome.

During the procedure

During a pyeloplasty, a doctor will:

• Apply general anesthesia to you. Throughout the process, you will be sleeping and pain-free.
• On the side of your injured kidney, make one or more incisions on your stomach.
• Remove the portion of your ureter that is obstructed or narrowed.
• Reattach your ureter to the renal pelvis of your kidney.
• In order to temporarily drain urine, a stent is frequently inserted either inside or outside the surgical site. Once your kidney heals, the stent will be removed.
• Seal off the incisions.

Two to three hours are often needed for pyeloplasty.

After the procedure

Following surgery, you can spend a day or two in the hospital. When a patient is in the hospital:

• Following the procedure, you will be allowed to eat and drink as usual. You will also be able to move around, but you should still listen to your doctor’s advice regarding how active you should be.
• To help prevent infection, a doctor may prescribe antibiotics.
• To eliminate urine from your body, you might get a Foley catheter or urinary drain. When you go home, a doctor will take it off.
• For a few days following surgery, you can experience bladder spasms or some discomfort due to ureteral swelling. You will receive pain medicine from your healthcare providers by injection, intravenous (IV), or oral (by mouth).

Outcome

Recovery from a pyeloplasty typically takes one to two weeks. You might experience some pain during urination or notice blood in your urine for about a week or until your doctor removes the stent. Generally, you can resume your normal activities in about three to four weeks after the surgery.

Your doctor will arrange follow-up visits to:

• Remove the stent: If the stent is external, your doctor will remove it by cutting stitches, and this usually does not require pain medication. If the stent is internal, its removal will involve a minor procedure done while you’re under anesthesia, so you’ll be pain-free during the process.
• Check for kidney swelling: An ultrasound will be conducted to monitor for any swelling in the kidney.