Surgery would be recommended only in the most severe cases.
Pyeloplasty is a surgery to relieve the obstruction to the flow of urine from the kidney to the long tube connecting the kidney to the bladder (ureter). This obstruction is called ureteropelvic junction (UPJ) obstruction. Surgery would be recommended only in the most severe cases. The goal of the surgery is to reduce swelling and pressure in the kidney by establishing a free flow of the urine. The most common surgical procedure used for the treatment of the swelling of the kidney due to the collection of urine (hydronephrosis) is pyeloplasty. Pyeloplasty repairs the block at the junction of the ureter and the pelvis of the kidney (UPJ blockage). It removes the narrowed or obstructed part of the ureter and reconnects the healthy portion to the kidney’s drainage system. The physician may perform pyeloplasty in:
- Traditional or open incision method
- Robot-assisted pyeloplasty
- Laparoscopic method
Hydronephrosis involves the collection of urine in the kidney due to incomplete emptying of the urinary tract, resulting in swelling and obstruction of the kidney. The swelling or obstruction can occur at:
- Opening of the kidneys into the ureters
- The ureters
- The bladder
- The urethra
Why is pyeloplasty done?
Pyeloplasty is done to repair an obstruction in the tube that drains urine from the kidney into the bladder (ureter). Pyeloplasty can help fix the problems due to urine flow obstruction, which include:
- Ureteropelvic junction blockage that develops before birth
- Blockages caused by polyps, tumors, or scarring
- Recurrent flank pain
- Recurrent urinary tract infections
- Pyelonephritis (inflammation of the kidney)
- Deterioration in kidney function
- Kidney stones
When should pyeloplasty be avoided?
Pyeloplasty is generally avoided in:
- Strictures (narrowing) longer than 2 cm
- Entrapment of ureter by the renal vessel (crossing renal vessel)
- Untreated coagulopathy (defect with blood clotting)
What to expect during a pyeloplasty?
Before the surgery:
- As this surgery is generally a planned one, the surgeon prepares you for the surgery.
- The surgeon may examine to assess the obstruction and function of the kidney.
- You may have to undergo a renal scan.
- The surgeon will assess your hemoglobin values and bleeding parameters.
- They may obtain your informed consent.
- You may receive antibiotics such as cefazolin.
During the surgery:
- Pyeloplasty is performed under general anesthesia.
- The surgeon makes three small incisions in the abdomen.
- Next, the surgeon inserts a telescope and small instruments through these holes.
- The surgeon removes the narrowed or obstructed part of the ureter and reconnects the healthy portion to the kidney’s drainage system.
- A stent is placed inside the ureter to drain the kidney.
After the surgery:
- You may be given intravenous fluids.
- You may be given painkillers to control pain.
- You may continue antibiotics, until the drain is removed.
- Recovery is faster in laparoscopic procedure than in the open procedure.
- You may be discharged from the hospital within two to three days.
- You can return to a regular diet after surgery.
- Avoid contact sports or cycling for six weeks.
- You may have to undergo imaging studies approximately six to eight weeks after the procedure.