Pyeloplasty Laproscopic / Robotic
Figure 1: Pyeloplasty showing removal of narrowed segment of PUJ and joining the two ends back together.
What are the indications for a pyeloplasty?
A pyeloplasty is needed when there is a blockage at the pelviureteric junction (where the urine from the kidney drains into the ureter tube).
What pre-operative work up is needed?
Your urologist will organise any necessary urine and blood tests and imaging scans including a CT scan (to check the anatomy) and a MAG 3 scan (to assess urine drainage) at your consultation prior to your procedure.
If you take any blood thinning medication such as aspirin, plavix (clopidogrel), warfarin or other anticoagulants, you should have a discussion with your urologist about whether these need to be stopped before your procedure.
Please ensure you return any admission forms given to you to be filled out back to the hospital.
What happens on the day of the procedure?
You will be given fasting instructions prior to your admission (it is usual to fast for 6 hours prior to the procedure). You should bring a list of your medications, and any recent scans or reports with you to the hospital. After you are admitted from the admission lounge, your urologist will see you to discuss the surgery. An anaesthetist will see you to discuss the general anaesthetic and pain relief options before you are taken to the operation theatre. You may be provided with a pair of TED stockings to wear to prevent blood clots from developing and passing into your lungs.
What does this procedure involve?
This involves repair of narrowing or scarring at the junction of the kidney pelvis with the ureter (the pelviureteric junction), performed through keyhole incisions. It usually involves putting in a temporary plastic tube (stent) to help healing.
After a full general anaesthetic and an injection of antibiotics before the procedure, a catheter is inserted into your bladder, during the operation. The operation is performed through 4 – 6 “keyhole” incisions after we inflate your abdomen with gas.
The narrowing at the pelviureteric junction is removed and the two healthy ends joined over a stent placed in your ureter (pictured below) to speed up healing. A drain is inserted close to the kidney to prevent accumulation of fluid.
The evening of surgery, you will be given a fluid diet only. You will be allowed to eat and drink normally the next day and encouraged to do deep breathing exercises and move around the ward. You will be given injections to thin your blood to prevent clots in the legs and lungs.
The catheter and the drain tube are normally removed in the following 1-2 days after the surgery. Most patients go home 2-3 days after the operation.
Are there any risks or side-effects?
Pain or discomfort at the incision site 50-80%
Shoulder tip pain due to irritation of your diaphragm 20-30%
Temporary abdominal bloating (gaseous distension) 20-30%
Irritative urinary symptoms and discomfort from stent 20-30%
Bleeding, infection, pain or hernia at the incision site requiring further treatment 2-5%
Continuing pain despite improvement in kidney drainage 5-10%
Recurrent narrowing or scarring requiring further surgery 5-10%
Bleeding requiring blood transfusion 2-3%
Urinary leakage from the joint 2-3%
Conversion to open surgery 2-3%
Recognised (or unrecognised) injury to nearby local structures (blood vessels, spleen, liver, kidney, lung, pancreas, bowel) requiring more extensive surgery 1-2%
Anaesthetic or cardiovascular problems possibly requiring intensive care (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death) 2-3%
What can I expect when I get home?
It will take 7-10 days to recover fully from the procedure. Most people can return to normal activities and light work duties after 2-3 weeks and strenuous activity and driving after 4-6 weeks if you are comfortable and the GP is happy with your progress.
Your stent may cause blood in the urine or pain in your kidney area, especially when you pass urine, or pain in your bladder; this usually settles quickly but in some patients may persist until the stent is out.
The keyhole incisions are closed with dissolving stitches, which do not require removal.
If you feel unwell, have a fever, difficulty passing urine or redness or discharge from your keyhole sites, you should contact your GP to check for a urine infection or come to the ED.
What follow-up will I need?
Your stent will be removed 4-6 weeks after the procedure, usually under local anaesthetic. Your urologist will arrange a MAG3 kidney scan 12 weeks after surgery, to assess the drainage of your kidney.