Endopyelotomy

PUJ Obstructions are caused when the funnel shaped kidney oart is narrowed or scarred, where it connects to the ureters. Endopyelotomy is a first-line treatment procedure which widens the renal pelvis, by small instruments insertion up the urinary tract, or through the skin into the kidney.
The obstructive tissue is then removed by burning/ cutting or lasers.

Advantages:

  • Better results in patient selective cases.
  • Minimal invasive.
  • Cost effective.
  • Low instruments cost
  • Least post-operative pain.
  • Shorter hospital stay.
  • Speedy recovery.
  • Safer modality.
  • Better quality of life post-treatment.
  • Surgery time: 3 to 4 hours.

Not Recommended For:

Patients with:

  • Crossing vessel
  • Preoperative differential split renal function.
  • Moderate/ acute hydronephrosis.

Symptoms:

If untreated, Ureteropelvic junction obstruction can result into:

  • flank/ abdominal pain.
  • Stones.
  • Urinary Infection.
  • High blood pressure.
  • Kidney function detoriation.

Diagnosis Tests:

  • Physical exam
  • EKG (electrocardiogram)
  • CBC (complete blood count)
  • PT / PTT (blood coagulation profile)
  • Comprehensive Metabolic Panel (blood chemistry profile)
  • Urinalysis

Preparation:

  • Avoid the following medications with doctors consutation: Motrin/ Aspirin/ Advil/ Ibuprofen/ Vitamin E/ Alka Seltzer/ Coumadin/ Ticlid/ Celebrex/ Lovenox/ Coumadin/ Voltaren/ Plavix/ Vioxx.
  • Few arthritis medications should be avoided 1 week prior to the date of surgery ).
  • Avoid drinking or eating after midnight before the surgery
  • If Recommended by doctor, then Magnesium Citrate.
  • 24 hours prior to surgery, drink only clear liquids like water or broths.
  • Avoid tomato/ orange juice.
  • Avoid milk/ cream/ marshmallows.

Treatment:

  • General anasthetia is given to the patient.
  • A telescopic device is inserted through the ureter into the bladder to the kidney.
  • Guidewires are passed into the ureter to the bladder and with the help of x-rays passed up the kidney.
  • A lser or cutting device is inserted upto the kidney junction.
    Sometimes, the kidney is even punctured from the top by inserting an instrument containing laser fibre or cutting device.
  • The obstructing tissue is then cut with the knife like cutting device or burned or destroyed by the laser device.
  • A ureteric stent may need to be placed post surgery.
  • Catheter may be placed if required.

Risks:

  • Urinoma
  • Ureteral/ vascular/ pulmonary injury.
  • Lost wire.
  • Stent-related abnormalities.
  • Uretery infection.
  • Unrecognized incision s
  • Obstruction
  • Stone formation
  • Procedure failure.
  • Pyelonephritis
  • Pyonephrosis
  • Vascular structure injury.
  • Constant flank pain.
  • Testicle/ ovary damage.
  • Gonadal artery damage.
  • Increased susceptibility to percutaneous renal drainage.

Follow-up:

  • Few days hospitalization.
  • Avoid tub baths.
  • Avoid alcohol/ coffee/ tea/ decaf/ carbonated products.
  • Avoid prolonged lying down/ sitting.
  • Avoid heavy weight lifting until full recovery.
  • Avoid strenuous physical activity until full recovery.
  • Urinary catheter for a week to 10 days, if at all.
  • Every one or two week doctor visit.
  • Resume gradual activity.
  • No driving for 1 week, post surgery.
  • After 1 week, can resume sexual activity.
  • Stent removal visit.
  • Contact your urologist immediately if you experience any of the above risk symptoms post surgery.

All above, treatments are finalized taking into consideration the overall health, severity, age and other ailments of the patient.