A Pyeloplasty is a surgical procedure on the renal pelvis in the kidney to treat PUJ (Pelvo-Ureteric junction obstruction), a condition which can cause symptoms and long-term complications.
This stands for Pelvo-Ureteric Junction. This is where the renal pelvis joins the upper end of the ureter, the tube through which urine flows from the kidney to the bladder. The renal pelvis is a funnel shape that has cup like extensions, called Calyces, within the kidney. Under normal conditions, the kidneys filter the blood and remove waste, salts and water to produce urine. This collects in the renal pelvis before it flows on through the ureter into the bladder.
An obstruction of the PUJ is when the kidney makes urine faster than it can be drained
through the renal pelvis into the ureter. This causes the urine to pool in the kidney, which leads to kidney swelling (Hydronephrosis).
This can cause symptoms such as flank pain, recurrent infections, blood in urine (haematuria) and lead to complications including loss of kidney function and kidney stones.
The cause of a PUJ obstruction can either be primary (congenital) – due to deficiency of muscle in the PUJ or a blood vessel crossing the PUJ. It can also be secondary, such as a stricture from a stone, previous surgery or tumour.
Once secondary causes have been ruled out, the diagnosis of PUJ obstruction is made with imaging including a renogram (MAG3 or DTPA). Treatment is only recommended if the PUJ obstruction is confirmed and is causing symptoms or complications. This is usually in the form of a pyeloplasty.
The operation is performed using 4-5 “keyholes” and using the latest da Vinci® Xi robotic surgical system.
The benefits of the robotic approach include:
Difference between key hole and open incisions
The aim of the procedure is to remove / excise the blockage and join the ureter back to the renal pelvis. After the blockage has been removed and the ureter reconstructed, a small plastic tube called a ureteric stent is placed inside the ureter to bridge the repair and help drain the urine from the kidney.
You will also have a urinary catheter following the procedure and this will usually be removed the following day.
Additionally, you will have a drain tube inserted at the conclusion of your surgery through one of the small incisions. It is there as a safety, in case of a urine leak from the join and will be removed by the nursing staff prior to your discharge from hospital. Pain at your incision sites is common and should improve with each day.
The ureteric stent can cause some discomfort, especially during urination where pain can occur in the back on the side near where the kidney is located. You may also experience some blood in your urine, urgency and frequency and this is normal. The stent is usually taken out 6 weeks post operatively and under a local anaesthetic using a cystoscope which is inserted into the bladder via the urethra. This is only a day procedure.
NOTIFY GEELONG UROLOGY or your GP if you experience any of the following:
You should have an appointment in 2-3 weeks with your doctor, at which point your stent removal procedure will be organised. If an appointment time is not given to you on discharge from hospital, please phone Geelong Urology.