Pyeloplasty - Procedure and Complications

What Is Pyeloplasty?

Pyeloplasty is a reconstructive procedure aiming to repair the tubes that join the kidneys and the bladder, known as the ureters. It is an inpatient procedure usually performed by a general surgeon or a urologist to correct the ureteropelvic junction obstruction. The patient will most likely remain in the hospital for two days after the procedure. The term pyeloplasty can be split into two halves, pyelo meaning kidneys, and plasty meaning a surgical procedure that replaces or restores something. This procedure can be carried out by people of all age groups, including children and adults. Studies have reported that one baby out of every 1500 is born with a ureteropelvic junction obstruction. Therefore, doctors will most likely do pyeloplasty in infants if their condition does not improve within 18 months. Older adults are more likely to undergo pyeloplasty if their kidneys remain obstructed.

Is Pyeloplasty an Invasive Procedure?

There are several methods by which a pyeloplasty can be done, but in babies and infants, an open pyeloplasty is usually done. The three ways in which a pyeloplasty can be done are listed below:

• Open Pyeloplasty - Open pyeloplasty or open surgery is a procedure in which a small cut is made in the skin and the tissues so that the surgeon is able to visualize the organs. Usually, doctors recommend open pyeloplasty surgery for babies because it is safer than laparoscopic surgery.

• Laparoscopic Surgery - It is a minimally invasive procedure usually done in adults in which the doctor makes several small incisions in the abdomen and inserts a tube into the urinary tract. The tube consists of a camera that helps visualize the internal structures, and the doctor does not have to put his hand inside the body.

• Robotic Surgery - As the name suggests, surgery is performed by a robotic mechanism in which the surgeon controls the arms of a robot. Several small cuts are made in the skin below the abdomen, and the procedure is done with robotic assistance.

How Should the Patient Prepare for the Pyeloplasty Procedure?

• The doctor will explain the procedure to the patient and ask him to sign a consent form that states that the patient is willing to do the procedure.

• The patient is not supposed to eat anything a few hours before the procedure.

• The patient must inform the doctor about his medications, including prescription medicines, over-the-counter drugs, and anticoagulants.

• After the blood and urine test reports have indicated that the patient is clinically fit for the surgery, the doctor will take the patient to the operating room.

What Happens During Pyeloplasty?

As pyeloplasty is a surgical procedure, it is done under general anesthesia, and the patient is unaware of his surroundings. The procedure is carried out in the following manner in infants and adults:

1. Infants or Babies - During the open pyeloplasty procedure, a two to three-inch-long cut is made below the baby’s ribs. Next, the obstructed segment of the ureters is removed or repaired. The ureter is then attached to the renal pelvis segment of the kidneys. Finally, a stent or a tube is placed into the body to facilitate urine drainage.

2. Adults - The surgeon makes multiple small incisions of size eight to ten millimeters near the abdomen. The robot assists the surgeon throughout the procedure. It has three to four robotic arms to hold the instruments and the camera. The range of movement of the robotic arm is similar to that of the surgeon. These robotic arms repair the uterus and connect them to the kidneys.

What Are the Complications of Pyeloplasty?

All surgical procedures are associated with risks and complications like heavy bleeding, damage to the surrounding organs, and conversion from robotic or laparoscopic surgery to open surgery. An anesthesiologist will review the risks associated with anesthesia. After the surgery, the patient might experience scarring, infections, hernia, and blood clots. Sometimes, the child might experience urine leakage from the point where the ureters join the kidneys. In addition, pyeloplasty might injure the following:

• Small intestines.

• Major blood vessels.

• Large intestine.

• Stomach.

• Liver, spleen, and pancreas.

• Ovary.

• Fallopian tubes.

• Urinary bladder.

What Happens After the Pyeloplasty Procedure?

Pyeloplasty helps resolve the problems of the kidneys and the ureters. The following happens after pyeloplasty:

• The patient will have to stay in the hospital for two to three days after the procedure.

• He should avoid eating for a few days after the procedure until the recovery is complete.

• The patient will be given intravenous antibiotics in the hospital. When he is discharged, the doctor might prescribe some oral medications.

• A JJ catheter or a percutaneous nephrostomy tube might remain in the urinary tract for a few days. This tube works as ureters until they heal and will be removed a few days after the surgery.

• Sometimes, the doctor might attach a drain to the abdomen to remove the fluid before the patient goes home.

• The patient’s ureters might be swollen, or he might have pain for a few days after the surgery. The doctor will prescribe painkillers that are to be taken orally or parenterally (injected into the body).

• The urinary bladder spasm is commonly seen after pyeloplasty because the catheter and other tubes irritate the bladder. So, the patient must not worry because there are other drugs that relax the bladder muscles.

• The patient might have difficulty urinating for a few days after the procedure, but the situation improves once the healing is complete.

How Should One Take Care Post-Surgery?

The patient should take care of himself after the surgery in the following ways:

1. Drink plenty of water.

2. Keep the wound on the abdomen covered with a bandaid until advised by the doctor.

3. Take showers, but do not bathe because it might cause infection.

4. Visit the doctor to get the stitches removed if they do not dissolve after some time.

5. During the follow-up visits, the doctor will examine the kidneys and remove the stent after a few days.

Under What Circumstances Should the Patient Consult the Doctor?

The patient must be careful about the procedure and consult his doctor if he notices the following symptoms:

• Nausea.

• Vomiting.

• Fever.

• Redness and warm skin around the incision.

• Pus discharge from the operated site.

• Severe pain that does not subside even after taking medications.

• Severe bleeding in the urine.

• Chest pain.

• Shortness of breath.

Conclusion:

Pyeloplasty is a surgical procedure done to resolve the problems of the ureters in infants and adults. Doctors usually prefer open surgery in infants and laparoscopic or robotic surgery in adults. This surgery is a boon for the ones who do not wish to undergo other surgical procedures or are having problems related to the passage of urine. Pyeloplasty has a good success rate if performed by a trained physician. So, the patient must not worry and consult the urologist at the earliest to know about pyeloplasty and its importance.