Laparoscopic Pyeloplasty

Laparoscopic Pyeloplasty is a minimally invasive surgical procedure used to correct a blockage or narrowing of the ureteropelvic junction (UPJ), the area where the kidney connects to the ureter. This blockage, known as UPJ obstruction, can cause pain, urinary tract infections, and kidney damage. Laparoscopic pyeloplasty restores normal urine flow by reconstructing the affected area.

Indications

The procedure is indicated for:

1. Ureteropelvic Junction (UPJ) Obstruction:
   • Congenital narrowing or scarring.
   • Acquired obstruction from stones, previous surgeries, or tumors.
2. Symptoms:
   • Flank or abdominal pain.
   • Recurrent urinary tract infections (UTIs).
   • Hydronephrosis (kidney swelling) on imaging.
3. Impaired Kidney Function:
   • Progressive loss of kidney function due to obstruction.

Preoperative Preparation

1. Diagnostic Workup:

   • Imaging: Ultrasound, CT urogram, or MRI to confirm obstruction and assess kidney damage.
   • Nuclear Renal Scan: To evaluate kidney function and drainage.
   • Blood and Urine Tests: To check kidney function and rule out infection.

2. Patient Counseling:

   • Explanation of the procedure, benefits, risks, and recovery timeline.

3. Anesthesia:

   • General anesthesia is administered for the surgery.

Surgical Procedure

1. Positioning:

   • The patient is placed in a lateral decubitus position for optimal access to the kidney and ureter.

2. Port Placement:

   • 3-4 small incisions are made for laparoscopic instruments and a camera.

3. Dissection:

   • The kidney and ureteropelvic junction are exposed by carefully dissecting surrounding tissues.

4. Resection of the Blocked Segment:

   • The narrowed or scarred portion of the ureteropelvic junction is excised.

5. Reconstruction (Anastomosis):

   • The ureter is reconnected to the renal pelvis in a tension-free manner to restore proper urine flow.

6. Stent Placement:

   • A double-J stent is temporarily placed in the ureter to ensure drainage and promote healing.

7. Closure:

   • The incisions are closed with sutures or surgical adhesive after ensuring no leakage from the anastomosis.

Postoperative Care

1. Hospital Stay:

   • Typically 1-3 days, depending on recovery and absence of complications.

2. Pain Management:

   • Analgesics are provided to manage discomfort.

3. Activity:

   • Early mobilization is encouraged to prevent blood clots and aid recovery.

4. Stent Removal:

   • The stent is removed 4-6 weeks postoperatively, usually under local anesthesia or mild sedation.

5. Follow-Up Imaging:

   • Ultrasound, CT, or nuclear scans may be performed to confirm improved drainage.

Benefits

• Minimally invasive with smaller incisions.
• Reduced postoperative pain and shorter recovery time compared to open surgery.
• High success rates (~95%) in resolving UPJ obstruction.
• Preservation of kidney function.