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PYELOPLASTY 

 

Pyeloplasty is a surgical procedure which is performed to reconstruct a part of the kidney and decompress the kidney. The main purpose of the surgery is to remove the obstruction between the kidney and the ureter, thereby, preventing long-term complications. These complications may include loss of kidney function, urinary infections or formation of kidney stones.

Before the surgery

The following preparation is necessary before undergoing pyeloplasty:

Few days before the surgery:

  • It is advisable to inform the doctor about all the medicines which are currently in use. This is because the doctor may suggest the patient to stop taking certain medicines which can increase the risk of bleeding. These include blood-thinning agents, herbal medicines, aspirin, etc.
  • Do not smoke as it can increase the risks associated with the surgery and can also delay the healing process

A day before the surgery

  • Do not eat or drink anything the night before surgery and until the completion of the surgery
  • Take all the necessary medicines only with a sip of water
  • Take enema or laxatives as suggested to clear off the bowel in preparing for the surgery

Procedure

Pyeloplasty may be performed in the following ways. It may take around 2-3 hours for completing the surgery. Before performing any of the below procedures, the patient will be given anesthesia to cause numbness either at the surgical site (local anesthesia) or the entire body (general anesthesia).

  • Laparoscopic pyeloplasty is a minimally invasive technique in which only three small incisions are made in the abdominal region. Through these incisions a laparoscope connected with a video camera and small surgical tools which are required to remove the blockage are inserted. Once the blockage is removed, a small tube called ureteral stent is placed inside the ureter to drain the urine. The incisions are closed with stitches and dressed properly. These sutures will dissolve in some days or may be removed manually after about 10 days.
  • Robotic laparoscopic pyeloplasty is similar to laparoscopic pyeloplasty. However, in this procedure a robot performs the surgery using surgical tools under the control of the surgeon. This helps in maintaining precision, flexibility and control of surgeon’s movements. Also, it involves less pain and bleeding, smaller scars and helps in a faster recovery.
  • Open pyeloplasty is an invasive technique in which one large incision is made to remove the blockage.

The main advantages of laparoscopic surgery when compared to open surgery include less postoperative pain and a faster recovery with less scarring. Therefore, it is most commonly chosen by the surgeons.

After the procedure

The patient may have to stay in the hospital for 1 to 2 nights after the surgery after which he/she can return home.

  • Symptoms such as constipation, pain in the abdominal region, discomfort and shoulder pain may be present for which medicines will be prescribed by the doctor.
  • A stent placed to drain the ureter is retained for about a week after the surgery.
  • The catheter placed to drain urine will be retained until the next day.
  • Solid foods should be avoided for a few days after the surgery due to the risk of nausea and vomiting. Only liquid foods or intravenous fluids may be taken.  
  • The health care team members will encourage the patient for an early mobilization, such as sitting on one side and walking slowly. This helps to improve circulation and prevents certain complications associated with the surgery.

Post-surgical care

The following measures help in faster healing after the surgery:

  • Do not drive or operate heavy machinery or involve in strenuous activities for about 6 weeks.
  • Take the medicines exactly as prescribed. Do not skip any dose.
  • Go for follow-up visits as directed so that the doctor will monitor the kidney function or change the dose of medicines if required.
  • If there are symptoms such as difficulty with urination, fever, excess bleeding, vomiting, irritability, then consult the doctor.

Risks

Similar to other surgeries, pyeloplasty is associated with certain risks which include the following:

  • Bleeding from the site of operation
  • Infection
  • Injury to the adjacent organs
  • Difficulty with urination
  • Side effects of the anesthetic agents
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