Pyeloplasty

What is pyeloplasty?

Pyeloplasty is safely effective surgery to perform reconstruction of scarred/ narrowed ureter-kidney attachment. This abnormality is termed as the UPJ- ureteropelvic junction obstruction, which results abnormal, problematic urine drainage from the kidney.

Advantages:

  • Better results.
  • Minimal invasive.
  • Least post-operative pain.
  • Shorter hospital stay.
  • Speedy recovery.
  • Safer modality.
  • Better quality of life post-treatment.
  • Surgery time: 3 to 4 hours.

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.
  • Through three 1 cm small incisions in the abdomen, a telescope, along with other small instruments are inserted.
  • This allows the urologist to repair narrowed/ blocked region.
  • A small tube ie catheter is inserted through the urine. The urine color might be pink to due to a few blood clots.
  • The color will be restored back to normal gradually.
  • At the end of the procedure, an ureteral stent, is placed in the ureter to drain the kidney and support the pyeloplasty repair The stent is removed a few weeks after surgery.
  • Another tube, a small drain, may be inserted in the area around the ureter and the kidney so as to facilitate the draining of extra fluid that maybe collect during/ post surgery and removed 1-2 days after surgery.

Risks:

  • Urinary odor
  • Reduced urine production.
  • Abnormally colored urine.
  • Bleeding
  • Hernia.
  • Urinary infections/
  • Open surgery conversion.
  • Tissue injury
  • Organ injury.
  • Failure to clear the obstruction.
  • Pain near the operated area.
  • Incision drainage.
  • Swollen/ red incision.
  • High fever.
  • Nausea.
  • Constipation.
  • Cramps due to gases.

Follow-up:

  • Few days hospitalization.
  • IV- Intravenous pain medications like Tylenol.
  • Avoid tub baths.
  • Pat dry incision areas immediately after baths.
  • Walking exercise as directed by the urologist.
  • Avoid prolonged lying down/ sitting.
  • No heavy weight lifting for 3 weeks.
  • No strenuous physical activity 3 weeks.
  • Urinary catheter for a week to 10 days.
  • Every one or two week doctor visit.
  • Resume gradual activity in about 4 to 6 weeks.
  • No driving for 1-2 weeks post surgery.
  • After 6-8 weeks, can resume sexual activity.
  • Stent removal after one month.
  • 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.