What is Pyeloplasty? Overview, Benefits, and Expected Results

Pyeloplasty is a type of‍ surgical procedure used to reconstruct the ureteropelvic junction (UPJ), a structure located at ​the point⁢ where the ureter meets the renal pelvis (the hollow part of the ⁤kidney collecting urine). Pyeloplasty is usually performed to relieve the obstruction of urine flow that results from ⁤UPJ obstruction, a condition caused by scarring ‌or ⁤other narrowing of the UPJ due to an abnormality at birth, an injury, infection, or inflammation.

What is the Ureteropelvic Junction?

The ureteropelvic junction (UPJ) is a structure located at the ⁣point where the⁢ ureter meets the renal ‌pelvis (the hollow part of ​the kidney collecting urine). The UPJ helps ⁤to ⁣control the flow of urine from the kidney to the bladder and plays an important role in⁣ maintaining the flow of urine from the kidney to the bladder.



When an UPJ​ obstruction occurs, the flow of urine from the kidney to the bladder is blocked, leading to a number of symptoms⁢ such⁢ as frequent or painful urination, back pain, and abdominal pain. The obstruction can also lead to an increase in pressure within the kidney, which can cause the kidney to become swollen and a condition called hydronephrosis.

What is Pyeloplasty?

Pyeloplasty is a type ⁣of reconstructive surgery used to relieve UPJ obstructions‌ by ‌relieving the blockage ⁣and restoring the normal flow‌ of urine from the kidney to the bladder. During the procedure, the surgeon‍ will make an incision in the abdomen and⁢ then reconstruct the UPJ with either a stented ureteroureterostomy,⁢ a pyeloureterostomy, or a pyeloplasty.

What Are the Benefits of Pyeloplasty?

Pyeloplasty offers a number of benefits for patients suffering from UPJ obstructions. These benefits include:

• Relief of symptoms: Pyeloplasty can⁢ help to alleviate the symptoms of UPJ‍ obstruction, including frequent⁤ or painful urination, back pain,⁢ and abdominal pain.



• Reduced hydronephrosis: Pyeloplasty‍ can help to⁣ reduce the risk of hydronephrosis, a ‍condition caused by the accumulation of fluid in the kidney due to blockage of the UPJ.



• Improved kidney health: Pyeloplasty can help to⁣ improve ⁤kidney ⁢function and reduce the risk of further kidney damage caused by the ‌UPJ obstruction.



• Increased urine flow: Pyeloplasty can improve the flow of⁢ urine from the kidney, helping to‌ improve overall urinary‍ health and ⁤reduce the‌ risk ‌of infection.
  
  
  
  

  What ‌Are the Expected Results of Pyeloplasty?

  
  
  
  
  The results of pyeloplasty vary from patient to patient, but most patients can expect to experience ‌an improvement ‍in ‍their symptoms and a reduction in the risk of hydronephrosis and further kidney damage. In some ⁣cases, pyeloplasty can also⁤ help to improve⁢ urine flow and​ reduce ⁤the⁤ risk of infection.
  
  
  
  

  Are There Any Risks or Complications Associated with Pyeloplasty?

  
  
  
  
  As with any surgical​ procedure, there are risks and potential complications associated with pyeloplasty. These risks and complications include:
  
  
  
  
  
  
  
  • Infection: Infections ⁤caused by the surgical procedure or anesthesia‌ are possible.
  
  
  
  • Bleeding: As with any ​surgery, there is a risk of bleeding.
  
  
  
  • Scarring: Scarring can⁢ occur in the area of the incisions. ⁣
  
  
  
  • Kidney damage:⁤ If the kidney is not functioning properly after the procedure, further damage may occur.
  
  
  
  • Recurrence of obstruction: In ⁢some cases, the UPJ obstruction can⁢ recur following pyeloplasty.
  
  
  
  
  
  
  
  

  Conclusion

  
  
  
  
  Pyeloplasty is a reconstructive ⁢surgery used to relieve UPJ obstructions and restore the normal flow of urine from the kidney to the bladder. The procedure offers a number of benefits ​for patients suffering from UPJ obstructions, including relief of symptoms, reduced hydronephrosis, improved kidney health, and increased urine flow. While the procedure carries​ some risks and potential complications, most patients can expect to experience an improvement in⁤ their symptoms and a reduction in the risk of hydronephrosis and further kidney damage.
  

  Definition and Overview

  Pyeloplasty is a surgical procedure that involves repairing the renal pelvis as a treatment for ureteropelvic junction (UPJ) obstruction, which is common among children.

  In the urinary system, the kidneys are responsible for filtering blood wastes and eliminating them by converting them into urine. Urine then flows from the kidney to the ureter then to the bladder, which has many nerves that are sensitive to the accumulation of urine. When it’s already filled, the sphincter muscles relax, allowing the urine to flow from the bladder to the urethra and then to the penis or vagina.

  However, there are times when the tubes encounter problems such as an obstruction. In UPJ obstruction, something is blocking the uteropelvic junction, which is the area where the floor of the kidneys and the ureter meet. When this happens, urine can go back up to the kidneys, a condition called hydronephrosis, damaging the organs by compressing them.

  Renal pelvis reconstruction is performed to remove the blockage, decompressing the kidneys in the process.

  Who Should Undergo and Expected Results

  Pyeloplasty is intended for people who have been diagnosed with UPJ obstruction. Although the condition can occur at any age, it is most commonly diagnosed among small children and even the ones still in utero. This is because hydronephrosis can be detected during a maternal ultrasound as early as the first semester. This means that as soon as the baby is born, the surgery can already be planned and executed.

  There are many possible causes of the obstruction including the growth of polyps or tumours, wrong positioning of a blood vessel, the presence of a scar tissue, and kidney stones. For those in utero, the problem typically occurs due to foetal development abnormalities such as when the tubes progressively become narrow, causing strictures (constrictions).

  Unless the condition has been detected during an ultrasound, the obstruction may not be easily determined as the child can be asymptomatic for some time. In the long term, he may begin to feel pain in the lower back where the kidneys are located, experience bleeding or pain when urinating, and develop recurrent urinary tract infections (UTI).

  The success of renal pelvis reconstruction depends on the severity of the condition. The earlier it is diagnosed, the better are the chances of avoiding permanent damage to the kidneys. Although the procedure can cure the condition in many cases, it cannot prevent the development of UTI in the future.

  How Does the Procedure Work?

  Pyeloplasty can be a traditional open surgery, in which a single large incision is made on the side, or laparoscopic, where three small incisions are made in the same area. This is then followed up by the insertion of a laparoscope, a long narrow flexible tube that contains a camera that feeds images of the organs and the surrounding tissues in real time to a monitor.

  Once the incisions are created, the urologic surgeon can proceed with the repair or reconstruction of the stricture by removing the blockage and connecting the ends of the ureter. There’s no need to use any artificial material to fix it. The stitches are then closed with dissolvable sutures.

  The surgeon will also insert a catheter to the bladder from the urethra to drain any urine buildup or allow the patient to urinate during the procedure. A stent may also be placed to keep the ureter open, although this is normally removed a few weeks once the operated area has completely healed.

  Renal pelvis reconstruction usually takes 3 to 4 hours and is performed under general anaesthesia, which means that the child is asleep and comfortable throughout the procedure.

  Possible Risks and Complications

  Inserting the catheter into the bladder may cause the urine to turn pink or brown. The patient may also feel the urge to urinate more frequently or feel discomfort and sometimes pain. Infection may also happen, so often, doctors prescribe antibiotics and pain mediations to the patient.
  
  References:

  • Elder JS. Obstruction of the urinary tract. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics.19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 534.

  • Frokiaer J, Zeidel ML. Urinary tract obstruction. In: Taal MW, ed. Brenner and Rector’s The Kidney. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 35.

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