Pyeloplasty Treatment & Diagnostics in Sadashiv Peth, Pune
Pyeloplasty
Pyeloplasty is a surgery performed to correct a condition called UPJ (ureteropelvic junction) obstruction, wherein there is a blockage in the renal pelvis of the kidney. The ureter is a long tubular structure responsible for carrying urine to the bladder from the kidney, where it is produced. This process is known as peristalsis. When there is a blockage in the ureter, this condition is called UPJ obstruction. Due to this blockage, urine gets backed up in the kidney and leads to an enlargement of the renal pelvis, known as hydronephrosis. This can further lead to kidney damage.
Causes of UPJ obstruction
Most of the time, UPJ obstruction is congenital, that is, children are born with this condition and it cannot be prevented. One in every 1500 children is born with a UPJ obstruction. It occurs when the ureter becomes narrow while fetal development, mostly due to an abnormality in the development of the muscle surrounding the ureteropelvic junction such as a blood vessel crossing over the top of the urine tube. UPJ obstruction can also develop in adults due to compression of the ureter by kidney stones, abnormal blood vessels, a tumor, scar tissue, or inflammation.
Symptoms of UPJ obstruction
After birth, signs, and symptoms of UPJ obstruction in children include:
- Flank pain in the back or upper abdomen, especially with fluid intake
- Urinary tract infection with fever
- Bloody urine
- Poor growth in infants
- Abdominal mass
- Kidney stones
- Vomiting
Diagnosis of UPJ obstruction
Generally, UPJ obstruction can be identified through prenatal imaging, even before any symptoms are present, as a swollen kidney can be detected on an ultrasound. Once the baby is born, additional tests would be required to confirm UPJ obstruction. These tests include:
- Blood urea nitrogen and creatinine tests – These tests would be performed to check the kidney’s function.
- Nuclear renal scan – In this test, radioactive material is injected into the bloodstream. As the material passes through urine, the doctor can examine if the kidney is working properly and how much blockage is there.
- Intravenous pyelogram – In this test, instead of radioactive material, a dye is injected into the bloodstream. As it will pass through urine, the doctor would be able to see if the ureter, renal pelvis, and kidney look normal.
- CT scans – Sometimes, a CT scan might be required if a child is having severe pain. This can show if an obstructed kidney is the source of pain. An MRI can also be performed to check the bladder, kidneys, and ureters.
Treatment of UPJ obstruction
If the obstruction is mild, it is generally left to heal on its own within the first eighteen months. The child would be given antibiotics to prevent infection and they would be monitored every three to six months. However, if the obstruction remains after eighteen months and urine flow does not improve, as in most cases of UPJ obstruction, a pyeloplasty would be required due to the potential for kidney damage.
Pyeloplasty surgery generally lasts for about three to four hours. First, the child is put to sleep using general anesthesia. Pyeloplasty surgery can be performed in two ways:
- Open pyeloplasty – In this procedure, the surgeon makes a 2 to 3 inches long incision below the ribs and the UPJ obstruction is removed. After this, to create a wide opening, the ureter is reattached to the renal pelvis. The urine starts to drain quickly and easily, once this is done. This will also relieve the symptoms as well as reduce the risk of any infections. The success rate of an open pyeloplasty is about 95%.
- Laparoscopic pyeloplasty – In this procedure, a ureter attaches to the kidney using a minimally invasive procedure.
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References:
https://my.clevelandclinic.org/health/treatments/16545-pyeloplasty#
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/laparoscopic-pyeloplasty
After a pyeloplasty surgery, most patients can recover quickly. Patients would have to stay in the hospital for one to two days after the surgery. Some patients might experience pain for a few days after the surgery and the ureter might be swollen for a while. As the area heals, kidney drainage also starts to become better. A few weeks after the surgery, your doctor will use an ultrasound to check for kidney swelling. Once the blocked kidney responds well to treatment, children can participate in sports or other activities. UPJ obstruction rarely comes back, once it is repaired.
Pyeloplasty has proven to be a safe procedure, however, with every surgery, there are some risks and complications associated, such as:
- Bleeding
- Hernia
- Infection
- Organ/tissue injury
- Failure to correct UPJ obstruction
It is common for children to experience some discomfort while urinating the first few times after the surgery. They might also feel the need to urinate frequently. For relief, the child should be made to sit in a tub of warm water. Placing a warm washcloth on the perineum also makes the child feel more comfortable.
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