In a healthy, functioning urinary system, urine flows from the kidneys through thin muscular tubes called ureters and into the bladder. Once in the bladder, urine is stored until it is expelled from the body through the urethra during urination. This process helps maintain fluid balance and eliminate waste products from the body, but it can be easily disrupted. In some instances, one or more of the ureters can become blocked, which disrupts the flow of urine and can contribute to uncomfortable symptoms and eventual kidney damage. Luckily, this is treatable with a procedure called a pyeloplasty.
What is a Pyeloplasty?
A pyeloplasty is a surgical treatment performed to remove a blockage or repair the narrowing of a ureteropelvic junction (UPJ). This is the area in the urinary tract where the kidneys intersect with the ureters to drain urine into the bladder. Without the surgery, the urine can be pushed back into the kidneys, causing pain, inflammation, infection, and a gradual decline in kidney function. It can also cause swelling and the accumulation of urine in the kidney, which is called hydronephrosis. During a pyeloplasty, the surgeon removes or fixes the blockage or narrowing area of the UPJ, allowing urine to flow from the kidney to the bladder.
About 1 in every 1,500 children is born with a UPJ obstruction. However, their doctor may recommend active surveillance to see if it corrects early in life. If the obstruction remains after 18 months, a pyeloplasty is usually necessary. Adults and older children may also develop UPJ obstructions. If you or your child experiences kidney pain or discomfort, an ultrasound will be done to check for swelling.
Reasons for a Pyeloplasty
There are several reasons that someone may need a pyeloplasty. These include:
- UPJ Obstruction —The most common reason for pyeloplasty is an obstruction in the UPJ. One or both of the tubes that drain urine from the kidney are blocked, and without intervention, the risk of complications remains.
- UVJ Obstruction — The ureterovesical junction is the lower end of the ureter where it meets the bladder. Narrowing or obstruction can also occur here, which often results in recurrent urinary tract infections.
- Other Blockages — In some instances, an external force may put pressure on the ureter and cause a kink or block, which affects drainage. For example, a blood vessel that crosses over the top of a ureter can narrow, resulting in symptoms like kidney pain and discomfort. Other potential blockages could include those caused by polyps or tumors.
- Urethral Strictures — Scarring along the urethral lining can lead to urethral strictures. These essentially cause the small tubes to become even narrower, making it difficult to empty the bladder. Although this is usually treated by placing a stent inside the ureter, a pyeloplasty may also be performed.
Pyeloplasty Benefits vs. Risks
Although minimally invasive, pyeloplasty is still a surgical procedure that carries unique risks. The most common risks include:
- Infection
- Scarring
- Excessive bleeding
- Blood clots
- Hernias
- Bad reactions to anesthesia
- Damage to blood vessels
- Damage to nearby organs
- Need for additional surgery
- Urine leakage
Still, pyeloplasty is a surgical treatment to relieve pain and prevent kidney failure, so it's often considered necessary. Some of the advantages of pyeloplasty include pain relief, reduced swelling in the kidney and ureter, and improved overall function.
How to Prepare for a Pyeloplasty
Your doctor will give you instructions to help you prepare for a pyeloplasty. Typically speaking, this includes following a few directions. Most commonly, your doctor will ask you to:
- Fast (no food or water) for eight to twelve hours before the procedures
- Discontinue unnecessary medication on the day of the operation, or only take them with a small sip of water (do not stop taking any medications unless explicitly told to do so by your doctor)
- Prepare to stay in the hospital following the surgical procedure
- Ask a friend or family member to drive you home
How Can Pyeloplasty Surgery Be Performed?
Pyeloplasty is generally considered a minimally invasive procedure, but there are several options for individuals who need treatment. Most surgeries take about two to three hours, and you may be required to stay in the hospital for a few days after surgery. The different surgical options include:
Laparoscopic Pyeloplasty
During laparoscopic surgery, small incisions are made in the abdomen, through which a thin tube with a camera and specialized instruments are inserted. The surgeon then accesses the UPJ and removes the obstructed portion of the ureter before reconstructing it to allow for proper urine flow.
Endoscopic Surgery
In this procedure, a thin, flexible instrument called an endoscope is inserted through the urinary tract, typically via the urethra, to access the UPJ. The surgeon can visualize and navigate the obstruction using advanced surgical tools passed through the endoscope, often without external incisions. Normal urine flow is restored after removing the obstructed segment and reconstructing the ureteropelvic junction.
Robotic Surgery
In this procedure, a surgeon operates with the assistance of a robotic system, which provides enhanced precision and maneuverability. Small keyhole incisions are made in the abdomen to insert robotic arms equipped with tiny surgical instruments and a high-definition camera. The surgeon controls these instruments from a console, allowing for intricate movements and a detailed view of the operative site in 3D.
Open Surgery
Open surgery requires a larger incision and is often used when the obstruction is complex or other options are not feasible. If a young child has a blockage, open surgery may be necessary to ensure damage to surrounding organs doesn't occur.
Post-Op Care for Pyeloplasty
After your surgery, you'll be able to eat and drink normally. Your surgeon will discuss any limitations or special post-op care, but you may need to stay in the hospital for observation for a few days. During this time, you'll be able to get up and move a bit, but rest is essential. Antibiotics will also be given to fight infection and need to be taken as prescribed. Many patients will have an indwelling catheter in place during their hospital stay. When you're able to go home, the catheter will be removed.
A thin tube called a stent will be placed to drain urine from the kidneys so the ureters can heal. The stent will stay in place until your doctor removes it at a follow-up appointment or a few days after surgery if you're still in the hospital. Your surgeon will provide more information based on your (or the patient's) age and the type of procedure performed.
Pain and swelling around the site of the surgery are normal and should slowly subside. You may also experience bladder spasms or ureter swelling for a few days. Pain medicine will be provided to you if needed during the healing process. Call the doctor for a follow-up if you notice any signs of infection or swelling around the kidney that doesn't subside in the weeks after the operation.
Recovery Time and Prognosis
Some people feel fully recovered from pyeloplasty one week after surgery, while others need more time. Typically, you can return to normal activities about a month after the operation, but it's important that you're cleared by your doctor first. To help aid the recovery process, it's important to drink plenty of fluids and follow your doctor's post-op instructions carefully.
Pyeloplasty has a 95% success rate, so the long-term prognosis is positive. However, if you notice any issues develop in the months after the surgery, it's important to contact your doctor to undergo further imaging tests. In rare cases, additional blockages may form.
If you or your child is experiencing urologic symptoms or conditions, it's important to have access to the right products and resources for ongoing management. That's why Byram Healthcare offers a wide selection of urology supplies that can be discreetly delivered to your door. Visit our urology products selection page to learn more.
