• WELCOME TO
    AVANTGARDE UROLOGY
    Center of Minimally Invasive Surgery

Pyeloplasty

In some cases, particularly in infants, PUJ obstruction may be mild and not require any treatment. Unless very severe, PUJ obstruction found in newborns often can be safely observed without treatment because, frequently, the blockage will resolve on its own as the child matures. A urologist will recommend periodic monitoring with lab tests, ultrasound and nuclear kidney scans. A small daily dose of antibiotic may be advised in newborns to prevent urinary infection that could damage the kidney.

Treatment may be required when symptoms are bothersome or kidney function is impaired by the obstruction.

In some, temporary kidney drainage can be obtained with an internal or external drainage tube. A ureteric stent is an internal drain running from the renal pelvis to the bladder within the ureter, while a nephrostomy tube drains from the renal pelvis out through the flank into a bag. This can allow treatment of infection, preservation of kidney function or relief of pain while corrective surgery is being planned.

Surgery aims to reconstruct a gradual tapering of the pelviureteric junction to allow unobstructed flow from the renal pelvis to the ureter. Various surgical techniques are available to correct PUJ obstruction. Your urologist will recommend the procedure most suitable to your specific circumstances.


Traditionally, PUJ obstruction has been repaired with an operation called a pyeloplasty. Under general anaesthesia, an incision is made in the flank through which the renal pelvis and ureter are exposed. The narrow PUJ is cut out or cut open after which a wider connection is constructed. A temporary stent or nephrostomy tube may be placed. Patients may be in hospital for up to seven days and able to resume their usual activities within four to six weeks. This operation is successful in about 90% of cases.

Today, it may be possible to perform a robotically assisted laparoscopic pyeloplasty. A series of "keyhole" incisions are made in the abdomen through which a narrow video camera and operating instruments are used to reconstruct the PUJ. This operation, although technically challenging, may allow a shorter hospital stay and recovery time.

Another alternative in adults is endopyelotomy, which involves making a cut through the area of obstruction in the PUJ using a scalpel, electric current or laser passed into the drainage system through a "scope". In a percutaneousendopyelotomy, a small incision is made in the flank through which a scope is advanced through the kidney into the renal pelvis to incise the UPJ. Ureteroscopic endopyelotomy involves passing a scope through the urethra, bladder and ureter to incise the PUJ. With either approach, a stent is required for several weeks postoperatively. These techniques may not be possible in all cases and have a success rate of about 70-80%.

If the kidney has very poor function, your urologist may recommend its removal (nephrectomy) rather than repair. This can be performed laparoscopically or via an open incision.

Follow-up
After PUJ obstruction is treated, follow-up can ensure that the affected kidney is functioning properly. This may involve periodic blood and urine tests, ultrasound and nuclear renal scans until it is clear that the problem has been corrected.
In some cases, particularly in infants, PUJ obstruction may be mild and not require any treatment, however, for these patients you should consult a Pediatric Urologist. A small daily dose of antibiotic may be advised in newborns to prevent urinary infection that could damage the kidney.
Unless very severe, PUJ obstruction found in newborns often can be safely observed without treatment because, frequently, the blockage will resolve on its own as the child matures. A urologist might recommend periodic monitoring with lab tests, ultrasound and nuclear kidney scans.

In adults, treatment may be required when symptoms are bothersome or kidney function is impaired by the obstruction.

In some, temporary kidney drainage can be obtained with an internal or external drainage tube. A ureteric stent is an internal drain running from the renal pelvis to the bladder within the ureter, while a nephrostomy tube drains from the renal pelvis out through the flank into a bag. This can allow treatment of infection, preservation of kidney function or relief of pain while corrective surgery is being planned.

Surgery aims to reconstruct a gradual tapering of the pelviureteric junction to allow unobstructed flow from the renal pelvis to the ureter. Various surgical techniques are available to correct PUJ obstruction. Your urologist will recommend the procedure most suitable to your specific circumstances.





Traditionally, PUJ obstruction has been repaired with an operation called apyeloplasty. In the past under general anaesthesia, an incision was made in the flank through which the renal pelvis and ureter are exposed. The narrow PUJ is cut out or cut open after which a wider connection is constructed. A temporary stent or nephrostomy tube may be placed. Patients stayed in hospital for up to seven days and able to resume their usual activities within four to six weeks. This operation was successful in about 90% of cases.

Today, we perform a robotically assisted laparoscopic pyeloplasty. A series of 3-4 "keyhole" incisions or a single-port incision through the belly-button are made in the abdomen through which a narrow video camera and operating instruments are used to reconstruct the PUJ. This operation, although technically challenging, may allow a shorter hospital stay (2-3 days) and recovery time (5-7 days) with excellent results identical of those of open surgery regarding drainage but much better regarding convalescence time and post-op pain control.




Another alternative in adults is endopyelotomy, which involves making a cut through the area of obstruction in the PUJ using a scalpel, electric current or laser passed into the drainage system through a "scope". In a percutaneousendopyelotomy, a small incision is made in the flank through which a scope is advanced through the kidney into the renal pelvis to incise the UPJ. Ureteroscopic endopyelotomy involves passing a scope through the urethra, bladder and ureter to incise the PUJ. With either approach, a stent is required for several weeks postoperatively. These techniques may not be possible in all cases and have a success rate of over 70-80%.

If the kidney has very poor function, your urologist may recommend its removal (nephrectomy) rather than repair. This can be performed laparoscopically or via an open incision.

Follow-up
After PUJ obstruction is treated, follow-up can ensure that the affected kidney is functioning properly. This may involve periodic blood and urine tests, ultrasound and nuclear renal scans until it is clear that the problem has been corrected.
Usually the adult patient undergoes a MAG3 test at 3 months and another MAG3 and Intravenous Urography at 12 months post-op.

Attention! The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with your physician for further evaluation.

Send your reply