LAPAROSCOPIC REPAIR OF PELVI - URETERIC JUNCTION OBSTRUCTION OR PUJ OBSTRUCTION

What is PUJ obstruction?

The urine formed in the kidney collects in the kidney pelvis. This pelvis is connected to the bladder by a tube called the ureter. Sometimes there is obstruction at the junction of the kidney's pelvis and ureter. If the obstruction is complete, the function of the kidney will be seriously affected. The obstruction can be present at the time of birth or later, at any age. The commonest age of presentation is early in adult life.

The cause of obstruction is usually a developmental defect of the muscle in this region. It can be due to other causes also, such as an abnormal kidney artery in this region producing mechanical obstruction.

How is it treated?

The treatment is by surgery. This can be done either by open surgery, with its accompanying morbidity of a 15 cm wound or in some cases, by endoscopic techniques ( endopyelotomy). By far, the best results are obtained by open surgical techniques. Now laparoscopy can do the same repair with the same results but avoiding all the morbidity of the open surgical wound and is considered by most Urologists as the gold standard.

Steps of repair

• Removal of the defective pelvi ureteric junction.
• Trimming down the renal pelvis.
• Reconstruction of the pelvis and pelvi ureteric junction over a stent. A stent is a tube made from special polyurethane or silicone. It helps in proper healing of the repair. It has to be removed after a few weeks.

Laparoscopic Repair

3 to 4 key holes are used. Only 1 muscle cutting 10mm or 5mm key hole at or near the umbilicus is used. All the others are either 5mm or 3mm key holes and are not muscle cutting. Hence the pain of the 1cm(or 5mm) muscle cutting wound is many times less than the 15cm or larger wound of open surgery! The wound complications are less and the recovery very fast. By1st post operative day after laparoscopy, the patient can easily get up without much pain, can usually begin to take a liquid diet and walk down to the toilet.

Pre Operative Preperation

• Medical fitness check up as outpatient about a week before admission.
• Admit the day before surgery.
• Laxative on the day of admission

Surgery

• Surgery usually takes 2 to 4 hours. You will be in the post operative ICU on the day of surgery and will return to your room only the next day afternoon.
• There will be a urethral catheter and a drain from the side of the abdomen.
• There will also be an internal stent (a 1.5mm tube) inside the ureter, the tube connecting the kidney to the bladder.

Post Operative

• Liquid diet (after doctor examines you) and later solid diet may be taken from the 2nd post operative day onwards.
• You will be easily able to get up without assistance and pain from the 2nd post operative day onwards.
• This includes walking without help to the toilet.
• The Urethral Catheter and drain will be removed usually by the 5th post operative day.

At Home

• No rest is needed at home.
• The internal stent will be removed as an outpatient in 6 to 8 weeks.

For Review

Routine review will be after about 1 week. Further reviews and follow up dates will be advised by your doctor at the time of the initial review.