Introduction:
The surgical operation known as a pyelocystostomy involves connecting the urinary bladder and the renal pelvis, which is the portion of the kidney that stores urine. When the ureter, the tube that transports urine from the kidney to the bladder, is clogged or injured, urine cannot freely flow from the kidney to the bladder, necessitating this treatment.
The ureter and renal pelvis are located by the surgeon during a pyelocystostomy after making an abdominal incision on the patient. After that, the surgeon makes a little incision in the bladder and attaches it to the renal pelvis. As a result, urine now has a new route to go from the kidney to the bladder.
What Is Pyelocystostomy?
A stoma (opening) made in the renal pelvis is known as a pyelostomy (kidney). This enables low-pressure urine drainage, which helps safeguard and avoid kidney damage (s). It is a medical treatment that frequently necessitates an overnight hospital stay. Patients with a condition called ureteropelvic junction obstruction frequently undergo pyelocystostomy (UPJO). UPJO is a blockage at the point where the ureter connects to the renal pelvis, which can cause urine to back up into the kidney and lead to kidney damage. Other disorders like ureteral strictures (narrowing of the ureter) and ureteral injuries are occasionally treated with pyelocystostomy.
Why Is a Pyelocystostomy Needed?
When there is an obstruction between the kidney and bladder, babies typically require a pyelostomy to drain urine from the kidney and relieve pressure.
What Is the Procedure of Pyelocystostomy?
Following are the procedure is done during pyelocystostomy :
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Anesthesia: To ensure that the patient is sleeping and pain-free during the procedure, general anesthesia is administered.
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Incision: To access the bladder, the surgeon creates an incision in the lower abdomen of the patient, just above the pubic bone. By gently separating the muscles and tissues in its vicinity, the surgeon exposes the bladder.
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Bladder Incision: To make room for the connection to the renal pelvis, a minor incision is made in the bladder wall.
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Identifying the Renal Pelvis: The portion of the kidney that stores urine—the surgeon gently pushes it down to move it closer to the bladder.
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Connection: The renal pelvis and the bladder are joined together by the surgeon by placing a stent, or tiny tube, into both locations and holding them there.
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Drainage: To allow any extra fluid to drain from the surgical site, a drain may be implanted.
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Incisions are stitched or stapled shut, and the patient is then brought to a recovery room for observation.
The patient might need to stay in the hospital for a few days following the procedure to be monitored for healing and to make sure urine is moving from the kidney to the bladder normally. In addition, the doctor will give instructions on how to treat the wound and when it is safe to resume daily activities.
What Are the Advantages Of Pyelocystostomy?
The fact that pyelocystostomy is less invasive and requires less recovery time than other surgical treatments is its key advantage. This is due to the fact that, unlike pyeloplasty, pyelocystostomy entails connecting the renal pelvis and urinary bladder rather than reconstructing the ureteropelvic junction.
Those who are high-risk for more invasive treatments due to prior surgeries or other medical issues may also undergo a pyelocystostomy. Patients with ureteral blockage and other disorders have also shown that it has positive long-term outcomes.
What Are the Complications Related to Pyelocystostomy?
Pyelocystostomy has some risks and probable problems, much like any surgical surgery. The following are some potential side effects of pyelocystomy:
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Bleeding: Excessive bleeding at the surgical site could occur during or after the procedure, necessitating further care.
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Infection: Each surgical technique could encounter this hazard. Individuals get an infection at the incision site or a urinary tract infection.
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Urine Leaking: Urine leakage from the surgical site is a rare occurrence but can be painful, uncomfortable, and need further care.
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Stent Migration: If the stent connecting the renal pelvis and the bladder moves or separates, it may restrict the urinary tract and necessitate additional surgery. Despite the fact that pyelocystostomy is successful in treating many patients, some may not see a significant improvement in their symptoms.
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Recurrence: Following the operation, the ureteral obstruction may occasionally return.
What Possible Instructions Are Given?
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Resuming their normal diet as tolerated.
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Activity: When the discomfort is fully under control, the child may go back to school or daycare.
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Wound Care: To keep the stoma open while it heals, the kid may need to have a catheter in place for a few days after surgery. A little slit surrounded by pink tissue marks the aperture. The pull-up or diaper will catch the urine as it drains.
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The skin at the pyelostomy site may swell up, turn red, and itch. Use a skin barrier ointment (such as Vaseline, Aquaphor, or another skin product) to protect the skin if this occurs.
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Give the kid a warm bath, or place a warm (not hot) damp washcloth over the stoma to check if pee starts to drain more readily, if someone does not notice urine draining from the stoma. Call the provider's office if the stoma is still not allowing urine to drain.
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Bathing: 24 hours following the treatment, we are free to take a bath. A regular warm bath will calm the body and aid in healing. For the following week, take 5- 10 minutes of plain water baths. If a tube is present, it should not be lower than the water's surface. The child can resume regular bathing once the tube has been taken out.
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Medicines: Acetaminophen should make the child feel better if they are in pain. Provide no aspirin.
Conclusion:
Overall, ureteral blockage and other disorders can be successfully treated with pyelocystostomy, which is a safe and effective surgical treatment. To ascertain whether a particular patient would benefit most from the surgery, it is crucial to go over the procedure's advantages and disadvantages with a licensed urologist.
