OVERVIEW

The pyeloplasty is a urological reconstructive procedure where the ureteropelvic junction (UPJ) is extended to facilitate the transport of urine from the kidney to the bladder.

The reasons for performing a pyeloplasty are the following:

  • Ureteropelvic junction (UPJ) obstruction (congenital condition)
  • UPJ obstruction (acquired by renal stones or previous surgeries)
  • Crossing of aberrant blood vessels in the UPJ (congenital condition)
  • Retrocaval ureter (congenital condition)
  • Recurrence of obstruction in the UPJ after another treatment such as laser endopyelotomy

Benefits of laparoscopic pyeloplasty

The purpose of performing the pyeloplasty is to restore the normal anatomy of the urinary tract and to facilitate the transport of urine from the kidney to the bladder and thus avoid permanent and irreversible damage to the kidney. In other words, pyeloplasty can save the kidney from possible irreversible chronic kidney failure.

When performed by laparoscopy, pyeloplasty is a surgery that offers rapid recovery and little postoperative pain.

Risks and complications

The possible complications that may occur when performing a laparoscopic pyeloplasty are the same that can occur with any surgical procedure and these are: hemorrhage, damage to nearby organs, reactions to anesthesia, etc. However, these complications occur infrequently and can be resolved mostly during the same surgery.

The risk of conversion to open surgery is low, (<5%), this may be due to difficulty in dissection or hemorrhage and is done to maintain patient safety.

Another risk of pyeloplasty is recurrence of the obstruction in the UPJ, this occurs in less than 10% of patients.

Alternatives to laparoscopic pyeloplasty

The aim of the pyeloplasty is to eliminate the obstruction in UPJ, this can also be achieved by a laser endopyelotomy, which consists of an endourological procedure (through the urinary tract) or an open pyeloplasty. Patients who are waiting for any of these corrective procedures can use a JJ stent, which allows the drainage of urine until the surgery is performed.

What to expect from laparoscopic pyeloplasty?

Day of surgery:

The day of the operation will arrive in the morning to the hospital in fasting

The surgery takes approximately 3 – 4 hours, however, the time is variable.

Anesthesia for this procedure is general, so you will be asleep during surgery.

Pain after laparoscopic pyeloplasty is minimal and can be effectively controlled with intravenous analgesics.

Food: on the day of surgery you can eat in the afternoon, there are no food restrictions, however, a balanced diet is recommended.

Physical activity: the same day of surgery you can walk in the afternoon. It is expected to feel a bit fatigued after any surgery, this problem resolves spontaneously a few weeks after laparoscopic pyeloplasty.

Hospital stay: most patients operated of laparoscopic pyeloplasty remain hospitalized for 2 to 3 days.

Wounds: Laparoscopic pyeloplasty requires 3 small incisions in the back (each 1 cm or less), once they heal completely, these scars can rarely be seen.

Catheter: after performing the pyeloplasty, a JJ stent is inserted into the ureter, which remains after surgery for 6 weeks to facilitate uniform healing of the urinary tract, this catheter is not visible because it is inside the body; However, some patients perceive slight discomforts such as burning when urinating, mild back pain, mild hematuria (blood in the urine) and urgency (frequent urination), the removal of this catheter is by endoscopy and can be performed as an outpatient procedure in the urologist office.

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