Introduction:
Urinary tract obstruction is a common condition and can affect any age group, including children and adults. Sometimes the person is born with defects in the urinary tract that causes problems later in life. However, there must be a smooth and free flow of urine from the body as it helps to get rid of the waste products, but sometimes it so happens that the flow of urine is blocked because of the obstruction in the urinary system. The principal organs that are present in the urinary system of humans are the kidney, urethra, ureters, and urinary bladder, blockage in any one of these organs can hamper the flow of urine. If the urine does not flow and remains retained within the body, it can be a potential source of infection and other side effects like kidney stones or pain.
What Is Urinary Tract Obstruction?
It is important to first understand the components or the organs present in the urinary tract because obstruction can occur in any of these organs. The following table summarizes the components of the urinary tract and their function:
In very simple terms, urinary tract obstruction means that there is some blockage that does not let the urine flow freely, thereby causing damage to the organs of the urinary system. The obstruction can be present for a long time or might suddenly be present, and it can be complete or partial. This blockage can occur in any of the above-mentioned organs. In all cases, urine flow is affected, increasing the risk of urinary tract infection. It can be congenital (present by birth) or occur during an individual's lifetime at a later stage, mainly affecting the elderly population.
What Are Some of the Signs and Symptoms of Urinary Tract Obstruction?
There are many signs and symptoms that people present in case of urinary tract obstruction. Some of them are listed below:
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Difficulty in passing urine.
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Unbearable pain in the lower back and abdomen.
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Increased risk of urinary tract infection.
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Severe urinary retention.
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Dysuria (painful urination).
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Hematuria (blood in the urine).
What Is Pyeloplasty?
Pyeloplasty is a surgical procedure done to repair the ureters that have become narrow due to ureteropelvic junction obstruction. The meeting point of the kidneys and the ureters is known as the ureteropelvic junction. The problem arises when this junction gets blocked due to several reasons. First, urine cannot pass from the kidneys to the ureters. As a result, it accumulates in the kidneys, causing them to swell and resulting in hydronephrosis. Pyeloplasty might need to be done in people of any age group, including children and adults. Studies have reported that one out of every 1500 babies born in this world suffers from urinary tract obstruction. Pyeloplasty is mainly done by a urologist and gets completed in three hours. However, the patient might need to stay for one to two days in the hospital.
What Happens in Pyeloplasty?
Pyeloplasty is an inpatient procedure, so the patient might need to stay in the hospital for two to three days. The doctor will explain the entire procedure, its benefits, and its risks. The patient must not eat or drink the night before the surgery. If he takes any medications, like anticoagulants or over-the-counter drugs, the doctor might ask to discontinue them a week before the surgery. During the procedure, multiple incisions are made in the lower abdomen. The surgeon visualizes the area with the help of a camera and removes the obstructed segment of the ureter. Finally, the ureter is reconnected to the kidneys, and a stent is left in place for a few days to facilitate urine drainage.
What Are the Complications of Pyeloplasty?
Pyeloplasty increases the risk of hemorrhage and damage to the surrounding organs. Sometimes, the doctor might have to switch to an open approach from the laparoscopic approach. Children might experience urine leakage and bleeding. Pyeloplasty might damage any of the following:
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Blood vessels.
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Large intestine.
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Stomach.
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Liver, pancreas, and spleen.
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Small intestine.
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Ovaries.
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Fallopian tubes.
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Urinary bladder.
What Is Stenting?
A stent is a tube inserted into the body to widen the blocked passages. The procedure of placing a stent into the body is known as stenting. There are different types of stents, and they are usually made of plastic or metal. They have a mesh-like structure and can be easily inserted into the arteries to widen them. The different types of stents are listed below:
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Airway Stents - As the name suggests, these stents are used in the lungs to widen the air passages. They are usually made of silicone because they can be molded into any shape.
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Aneurysm -An aneurysm is a bulge in the aorta wall due to weakened artery walls. A stent graft usually treats aneurysms. It is a tube-like structure made up of polyester and a metal-mesh backbone. They provide a channel for the blood to flow freely.
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Carotid Artery Stents - The following stents are commonly used in coronary arteries:
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Bare Metal Stents - They are metallic tubes having a mesh-like structure and can be used in both coronary and carotid arteries.
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Drug-Eluting Stents - Drug-eluting stents are the ones that are coated with medicines that get released when these stents are inserted into the artery.
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What Type of Stent Is Used in Urology?
Urology is a branch of medicine that deals with the study of urologic and gynecologic disorders. After many surgical procedures, stents are used in urology to facilitate urine drainage and widen the ureters. People mostly need stents temporarily, but sometimes they might require a prolonged duration. Ureters are tubes that might obstruct due to stones, tumors, and other conditions. As a result, the patient experiences difficulty passing urine and suffers from several diseases. So, the doctors usually insert these stents to widen the ureteral passage and allow the smooth flow of urine. Ureteral stents are made of silicone or polyurethane and are about 10 to 15 inches long. They are present along the lining of the ureter and help to keep it open. The stent has a coil at one end and a loop. The coil stays in the kidneys, whereas the loop remains in the bladder.
Can Stents Be Used After Pyeloplasty?
The use of stents in pyeloplasty is a topic of research, and scientists are continuously trying to evaluate the effects of stents on pyeloplasty. Studies have reported that stented pyeloplasty reduces the risk of complications, and the patient does not have to stay in the hospital for long. The other complications of stented pyeloplasty based on research are listed below:
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Some patients need to be admitted to the hospital a few days after stented pyeloplasty because they develop swelling in the lower back and abdominal region. It is because the stent might have migrated from its position and the fluid accumulated near the kidneys.
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Pyonephrosis or kidney infection and urosepsis were commonly seen in infants who underwent stented pyeloplasty.
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People also reported urine extravasation or urinoma because of the accumulation of urine in the area outside the kidneys.
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The patients who undergo stented pyeloplasty are more likely to develop urinary tract infections because the urine remains in the body for a long time and provides a medium for bacterial growth.
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Painful urination (dysuria), hematuria (blood in the urine), and urinary frequency (urinating more than eight times a day are some of the issues related to stented pyeloplasty.
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Stents have a loop at one end that stays in the bladder, and studies have reported that trigonitis or inflammation of the bladder neck is commonly seen after stented pyeloplasty.
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Children who underwent stented pyeloplasty often reported suprapubic pain and vesicoureteral reflux.
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When the urine flows back into the bladder instead of flowing outside the body, the condition is known as vesicoureteral reflux.
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The researchers have noted that the stents migrate from their positions in 2.5 to 16.6 % of the cases.
Conclusion:
Urinary tract obstruction is a common condition that might be present congenitally or acquired by an individual due to tumors, cysts, stones, or strictures. Sometimes, babies are born with underdeveloped ureters or kidneys, which might later become the reason for urinary tract obstruction. Stented pyeloplasty is not only done in adults but also in infants who are born with urinary tract obstruction or diagnosed with it during an ultrasound. The advantage of the procedure is that it is minimally invasive and can be done by a laparoscopic approach. However, the disadvantage of the procedure is that there are several complications associated with it and the patients are more likely to develop kidney infections. Consult a urologist to know more about stented pyeloplasty and its risks.
