Pyeloplasty Surgery: Purpose, Procedure, and Benefits and Side Effects

Pyeloplasty is a surgery done to treat ureteropelvic junction (UPJ) blockage that prevents urine (pee) from reaching the bladder. Here in the term, pyeloplasty, kidney is referred to as ‘pyelo’ whereas the word ‘plasty’ refers to a surgical treatment used to replace, restore, or repair anything. The obstruction that is needed to be removed with pyeloplasty surgery can be due to two main reasons;

Most of the time, pyeloplasty physically removes a blocked portion of the urinary tube called the ureter. However, due to an anomaly in the development of the tube when a baby is still growing in the womb, these obstructions frequently occur in uretero-pelvic junction, or UPJ region which is an area that connects the renal pelvis (part of the kidney) to one of the tubes (ureters) that move urine to the bladder. This kind of abnormality is called a congenital condition (present from birth).

Other times, the UPJ is being blocked or pushed against by another bodily component, making it difficult for urine to pass. For instance, a blood vessel may cross the top of the urine tube, causing a space to become smaller. This may result in back or side pain, which frequently precedes kidney pain. Pyeloplasty in these situations entails cutting the urinary tube and removing it from behind the blood vessel. So that the urine flow is no longer obstructed, the tube is then rejoined above the blood vessel.

There are six methods for doing the surgery:

A few centimeter-wide incision is made around the affected side. To observe and operate on the child directly, the surgeon pulls back the skin. Young babies typically undergo this procedure.

Several very small cuts (a few millimeters wide) are made in the abdomen during laparoscopic surgery. The surgeon works from the outside of the belly while holding a long, thin ‘tube’ that includes equipment and a camera inside the tiny holes.

The abdomen is cut with a number of extremely small (a few millimeters wide) incisions. The robotic arms are guided by the surgeon's computer as they move tiny instruments under the skin to do the procedure.

This operation is similar to laparoscopic procedure, with the exception that in place of the nephroscope, a ureteroscope is introduced into the bladder and guided up to the renal pelvis. The stent is placed from the bladder to the pelvis after the constricted portion is removed. This procedure can be done in an outpatient setting.

In this procedure, the region above the upper pole of the kidney is incised to introduce the nephroscope up to the renal pelvis and constricted region. A camera is then used to guide micro equipment via the scope and the narrowed part is cut. After the ureter and pelvis have been sewn together, the surgeon places a stent from the pelvis up to the bladder that is left there for roughly 4-6 weeks. The main benefit of the operation is a quicker recovery time due to a smaller incision and less blood loss.

Similar to retrograde pyeloplasty, a cutting wire and a balloon catheter are utilized during an acise endopyelotomy. The cutting wire is attached in front of the balloon catheter which has contrast material. The acucise catheter travels to the pelvis through the bladder. The balloon is inflated once it reaches the ureter, and a fluoroscope is used to determine its position. The narrowed space is then cut by the cutting wire and the catheter is removed after a ureteric stent has been implanted.

Pyeloplasty surgery can benefit patients in so many ways;

• It can provide the protection to the kidney from any harm or infection
• Let the kidney operate better than when it was obstructed
• Off loads your other kidney by not putting it under too much pressure
• Pain relief
• Treats recurrent urinary tract infections
• Has the highest success rate compared to other surgical options for UPJ obstruction

Also, as pyeloplasty restores the functioning of the affected kidney, in the event of damaged or compromised kidney, having two healthy kidneys is always the best option.

When the tube that carries urine from the kidney and into the bladder is blocked, forcing the urine back into the kidney, a pyeloplasty is performed to treat the condition. If left untreated it could lead to infections, discomfort, and renal function loss. Pyeloplasty can assist in resolving these issues and guard against their recurring or getting worse.

The most common cause for pyeloplasty surgery is ureteropelvic junction (UPJ) blockage that usually occurs in the renal pelvis, however, any obstruction that develops in the urine's pathway from the renal pelvis to the ureter is known medically as a UPJO.

Although the cause of this obstruction may not be known, one of the following reasons are typically diagnosed:

A blood vessel that crosses the ureter and applies pressure to a blockage The term ‘congenital narrowing of the ureter’ refers to a non-functioning portion of the ureter that may exist.

One may need pyeloplasty for the following conditions:

An adynamic ureter or blocked UPJ: In many kids, the obstruction appears before birth and has a small, constrictive area that is just too small to allow enough urine to pass through. However, in other situations kids' UPJs can be normal, but something other than the ureter - like a crossing vessel - causes the obstruction. This is referred to as an external blocked UPJ and often affects older kids.

Rare causes: These may include obstructions brought on by tumors, polyps, or scarring. Many cases of clogged tubes are identified before delivery when an ultrasound reveals a bloated kidney (hydronephrosis). After birth, these infants undergo ultrasounds and other imaging procedures to determine the reason for the obstruction and whether surgery is necessary.

In other instances, children often visit a doctor with symptoms including vomiting, flank, back, or abdominal discomfort, urinary tract infections, blood in their urine, or kidney stones that are all linked with a clogged pee tube.

The risks of a pyeloplasty are generally the same as those of any surgery, including;

• Infection
• Swelling
• Bleeding
• Failure of the procedure
• Urine spill during the surgery that may irritate nearby tissues

Rarely, a scar that prevents urine from reaching the bladder develops where the pee tube is stitched together. This causes the tube to get obstructed once more. You could need a second procedure in these circumstances to cut through the scar tissue or remove the new blockage. The radiologists may be able to dilate this new obstruction occasionally without doing additional surgery. It may be necessary to use another tube to help drain urine that occasionally continues to leak where the pee tube is sewn together.

Despite the risks, a pyeloplasty surgery can be a good choice for people with kidney blockage. The chances of countering the risks and side effects can also be ignored or reduced if the surgery is done by an expert urologist at Pristyn care.

Once the problem is identified and a surgical procedure is suggested by the healthcare provider you will be scheduled for pyeloplasty which is quite a safe procedure. Here are some instructions to help you prepare for the surgery;

• It's crucial to take proper rest before the surgery, and if you're feeling particularly nervous, try deep breathing
• You are not supposed to eat or drink anything prior to your surgery. Do not even drink the water. Just sip it or gulp with your saliva if you are taking any suggested medicine
• You should take off any jewelry before surgery
• Take a bath before reaching hospital with preferably with an antibiotic soap
• Prefer wearing loose gowns or something that doesn't fit on your waist
• Tell your doctor the medication or any supplements you are on
• Stop taking blood thinning medicines
• Arrange someone to take you home back from the hospital and help you around the house

Prior to your scheduled surgery, your doctor will go over the surgical plan with you as well as what to anticipate during the office visit.

Pyeloplasty which is a surgical reconstruction of the renal pelvis (a part of the kidney) is often performed by surgeons to alleviate uretero-pelvic junction (UPJ) obstructions through several methods.

A ureteropelvic junction (UPJ) obstruction can result in slow-moving urine that often goes back to the kidney due to the blockage. The condition may cause bruising, inflammation, high blood pressure, flank and stomach pain, as well as kidney damage and bruises.

• ​​You must sign a consent document, discuss the operation with the anesthesiologist, and adhere to any other requirements your hospital may have before your surgery
• A general anesthesia will be administered to put you to sleep
• During the procedure, a catheter will be inserted and kept in place all night
• The doctor will also insert a stent (a small tube) into the urinary tube if the procedure is minimally invasive to aid in the tube's recovery
• After surgery, the stent will remain in place for several weeks
• If the operation is open, the surgeon may insert a tiny tube (known as an external drain) to empty urine from the injured kidney to the outside of the body while the kidney and urinary tube recover. After surgery, this will remain in place for a few days to a few weeks
• To assist reduce the likelihood of an infection at the site of the incisions, your kid will be given at least one dosage of antibiotics
• In order to confirm that there is a blockage, your surgeon may take a few last-minute photos by injecting dye up your child's ureter to the kidney
• Known as cystoscopy and a retrograde pyelogram, this non-invasive procedure is done to better visualize your child’s anatomy

As ureteropelvic junction (UPJ) blockage can affect any age group and can even develop in children growing in the womb, it is treated with different approaches in both infants and adults. The procedure typically lasts three to four hours. The procedure is done as following;

• In babies/infants: During an open pyeloplasty, the obstructed ureter segment is removed through a two to three inch incision made right below your baby's rib cage. Following that, their normal caliber ureter is reattached to their renal pelvis. To drain kidney urine, a thin silicone tube called a stent is implanted. The stent will be taken out once they have recovered.
• In adults and older children: A number of tiny incisions, each between eight and ten millimeters long, will be made by the surgeon. Your surgeon's robot assistant has three to four robotic arms. One handles a camera while two to three others use instruments. The UPJ obstruction can be fixed using the tools' equivalent range of motion to the human hand by removing the narrow, scarred portion and reattaching the normal tissue.

The following things will happen to you or your child immediately following the procedure while you are still in the hospital:

• ​​Your youngster will be examined for any issues in the recovery area
• If they are doing well, they can be transferred to a regular hospital room for the recovery, where you can meet them
• Your nurse can administer medication to help you feel better if you have nausea following the anesthetic
• You'll be able to eat and drink shortly after the operation, and recovery is typically swift
• Following surgery, you should try to stand up and move about, but avoid strenuous activity
• Intravenous antibiotics will be administered to you (antibiotics through a tube that goes into your arm). Oral antibiotics may be given to you before being discharged home
• After surgery, your child may notice some traces of blood in their urine which is typical
• The hospital staff will take care of your foley or urine catheter
• You might have a percutaneous nephrostomy (PCN) tube or a double-J (JJ) catheter. This tube is inserted into the urinary system either from the stomach (JJ) or the back (PCN). To give your ureter time to heal, these tubes carry out their functions. After your procedure, the PCN tube will be taken out shortlyTo move any extra fluid, you may occasionally have a drain placed to your belly, close to the incision. You should take it out before your discharge from the hospital
• Perhaps your ureter is enlarged. After surgery, you can have some pain for a few days. Your medical professionals will administer painkillers to you intravenously, orally, or via an injection
• A bladder spasm can also be the cause of additional discomfort. As after surgery your bladder may suddenly feel irritated and tight due to the catheters and other tubes, you may also be given medication to relax it and lessen your pain
• Initially after surgery kidney drainage may be inadequate but with time this subsequently gets better as it heals.
• If your child is doing well, the surgical team may decide to send him or her home the following day after checking on them.

In India, cost of pyeloplasty surgery is around INR 50,000. However, as with any operation, the precise cost may vary a bit based on the method used for your pyeloplasty, your choice of surgeon, their level of experience, the location of the hospital, as well as additional medical and non-medical costs.

The following is a summary of the approximate costs for pyeloplasty surgery in several Indian metropolises:

The costs may range based on the hospitals in other cities and can range somewhere between INR 50,000 to INR 60,000. The price of a pyeloplasty in Hyderabad is INR 60,000, in Delhi the procedure can cost INR 60,000, Mumbai INR 60,000, whereas in Chennai it can go up to INR 60,000, Kolkata around INR 60,000, Ahmedabad approximately INR 60,000, and Kochi INR 60,000, while in Chandigarh it can cost INR 60,000, and in cities like Bangalore and Lucknow it can cost INR 60,000 and INR 60,000, respectively.

A lot of variables may affect the cost of surgery. Along with tier-1 or tier-2 cities; hospital or clinic brand names, the fees of the treating consultant, admission fee, type of the surgery, post-surgical complications that are involved, admission room that you opted for, may have an influence on hospital billing expenses.

The total cost of the procedure may also be impacted by the number of diagnostic tests performed. The entire cost of the surgery may decrease based on the patient's insurance plan.

After pyeloplasty you may go home on a regular diet. However, to treat conditions like constipation that may result from anesthesia and painkillers you are taking, include a more fibrous and hydrating diet. Here are some foods that are idle for patients who have undergone pyeloplasty and want a safe and healthy recovery;

• Lots of water around 8-10 (8 oz.) glasses a day
• Juices
• Whole wheat bread
• Apple
• Pear
• Prune
• Curd

Pyeloplasty surgery is a surgical minimally invasive reconstruction procedure, hence it is safe and very simple for treating ureteropelvic junction obstruction (UPJ). The surgery can also save the patients from any infection, and other complications arising from the delay in treatment. Pyeloplasty is also known to give the patient quality life and also relieves them from the pain and discomfort.

The whole procedure is done under general anesthesia, hence the surgery itself isn’t painful. However, after pyeloplasty, you or your child might experience some pain that can be managed with medications. The pain may go away in a week as the area heals.

Typically, recovery takes 3 to 4 weeks for a laparoscopic procedure, as opposed to 8 weeks for open pyeloplasty. After 2 to 4 weeks, most people can resume their regular activities. The ureteric stent may cause some discomfort when you pass urine and may also cause you to notice traces of blood in your urine.

Though the surgery is pretty safe yet there are some risks and side effects of pyeloplasty as well just like any other surgical procedure. Side effects following pyeloplasty surgery include;

• Scarring
• Infection
• Hernia
• Internal urinary leakage
• Damage to major blood vessels
• Blood clots
• Obstruction may recur

After surgery, take excellent care of yourself. It is best to have a caretaker with you who can help you with household chores. Anyone who undergoes pyeloplasty should:

• Drink a lot of water
• Take some rest
• Do not indulge in strenuous physical labor for at least six weeks
• Keep the bandages/dressings on the abdomen as long as the doctor instructs, typically for 24 to 48 hours
• For the first seven days following surgery, take a quick shower or sponge bath as soaking could infect your surgical wounds. After a week, you can start bathing normally again
• Take all prescribed painkillers and laxatives as directed. Please take all medications exactly as your doctor has instructed
• If your stitches are not soluble, go back to your doctor on the scheduled day to get them removed
• Always look out for any signs of infection such as a fever, warm skin or redness around the incision, pus or drainage. If any of these signs show up visit your doctor
• Please call the clinic to schedule an appointment if you have a drain on the side so that it can be taken out in the clinic about a week after discharge
• The stent placed to drain the excess fluid from your kidneys during the surgery will also be removed a few weeks after surgery during a quick procedure under topical anesthetic. Your doctor may also use an ultrasound to look for enlarged kidneys

Pyeloplasty is occasionally used to treat ureteropelvic junction (UPJ) blockage, a condition in which part of the kidney gets blocked because of excess fluid in them due to no excretion of urine. The condition could be due to any reason such as birth anomaly, any blood vessel that crosses the ureter and applies pressure, as a result causing a blockage, or obstructions brought on by tumors, polyps, or scarring.

Popular method to treat pyeloplasty is the laparoscopic method that has fewer small incisions and is less complicated and promises faster recovery. The surgery is done to avoid any future infection or complication arising due to the blockage of the kidney due to the accumulation of excess urine.