Urine produced by the kidney is collected in the kidney pelvis. From kidney pelvis urine flows to urinary bladder through ureter, the tube connecting the kidney and bladder. Blockage to the flow of urine experienced in the junction of ureter and kidney pelvis is known as pelvi-ureteric (PUJ) junction obstruction. This is usually found as a genetic abnormality. Stones and cancer can also cause PUJ obstructions. Urgent treatment is warranted in such cases as the situation can lead to severe pain, infections and damage to the kidneys.
Open surgery: Traditional open surgery needs a long cut about 9 inches in size along the ribcage on that side. Though the success rate is better it is very painful procedure and needs about 7-10 days hospitalization and takes 6-12 weeks for complete recovery.
Balloon dilation: In this procedure with the help of a balloon inserted through the bladder, and necessary corrections are made. Though this procedure has a success rate of 75 %, the result is not predictable and is not suitable for all patients.
Endopyelotomy: In this procedure a telescope is inserted either through the kidney or the bladder and with the help of this telescope the obstructions are removed. Success rate of this procedure is 80 % and this procedure is not suitable for all patients.
Laparoscopic pyeloplasty: Laparoscopic pyeloplasty was introduced in the year 1993 and since then it has become the most popular and convenient surgical procedure for removing PUJ obstructions as it has a high success rate of about 95 % and as it can be carried out on almost every patients. Many urologists consider this as the gold standard for removing obstructions in the kidney pelvis. The four important steps in laparoscopic pyeloplasty are furnished below.
1. Removal of impaired pelvi-ureteric junction(PUJ)
2. Repairing the pelvis
3. Pelvi-ureteric junction re construction with the help of a stent. Stent is a tube made of silicon or polyurethane.
Only one incision of about 5 to 10 mm is size with muscle cutting is needed in this surgical procedure. Other two or three incisions of the size 3 to 5 mm which does not involve any muscle cutting are required for carrying out this surgical procedure. As the incisions are smaller there will be very less pain in this surgery. If some difficulty is experienced in completing the surgery during the procedure, it will be converted as an open procedure. This happens in only in about 4 % of laparoscopic pyeloplasty surgeries.
Pre operative preparations
Medical checkups will be completed one or two weeks prior to the surgery date. The patient will be admitted to the hospital on the previous day of the surgery and laxatives will be given soon after admission.
Surgery will take 4-5 hours. After surgery the patient will be removed to recovery room where he will be under intensive care. The patient is usually brought to his room on the next day in the afternoon. A urethral catheter and a drain to the abdomen will be there. An internal stent will be there inside the ureter.
Post operative care
Liquid diet can usually be given on 2nd post operative day of the surgery which can be converted to normal diet slowly. On the next day of the surgery the patient will be able to walk to the toilet without anybody’s help. Urethral catheter and drain will usually be removed on the fifth day of the surgery and the patient will be discharged within one week. No rest is needed at home. The internal stent will be removed after 6-8 weeks as an outpatient procedure.