Pyeloplasty

What is Pyeloplasty?

Pyeloplasty is a surgical procedure to remove the area of blockage at the pelvic ureteric junction (PUJ).

Why is a Pyeloplasty Performed?

The kidneys filter the blood to produce urine, which passes through the renal pelvis, a funnel-shaped area on each kidney, to tubes called ureters that lead to the bladder. 

A blockage can sometimes occur at the junction of the renal pelvis and the ureter called the Pelvic Ureteric Junction (PUJ), causing urine to accumulate and damage the kidney.

Cause of Pelvic Ureteric Junction Blockages

This condition can occur due to 

• an abnormally developed PUJ, 
• the presence of kidney stones, 
• scar formation, 
• infection, 
• backflow of urine (vesicoureteral reflux) or 

a vessel that compresses the area (known as a crossing vessel). 

Types of Pyeloplasty

Dismembered Pyeloplasty

Dismembered pyeloplasty is usually the technique of choice for most pelvic ureteric junctions (PUJ). 

• It involves dismembering or separating the ureter along with part of the renal pelvis and re-joining it to a more favourable area after dissecting any excessive renal pelvis tissue and widening the upper end of the ureter. 
• If a crossing vessel is the source of obstruction, the pelvic ureteric junction is moved in front of it. Any stones present are destroyed or removed.

A Pyeloplasty is traditionally performed through open surgery, but Dr Hadley offers a minimally invasive approach (laparoscopic or robot-assisted) that allows enhanced cosmesis and recovery.

Open Surgery

A large incision is made on the side with the PUJ obstruction. The skin and deep layers including muscles are pulled aside so the area of PUJ obstruction can be directly seen and repaired successfully.

Laparoscopic Surgery

Several small cuts (5-8 mm wide) are made in the belly. Dr Hadley operates long, thin “sticks” with tools inside the tiny holes from the outside of the belly, while his assistant holds a camera to enable keyhole repair.

Robotic Surgery

Several small cuts (8 mm wide) are made in the belly. Dr Hadley uses a robotic console to control the robotic arms, which move small tools underneath the skin to do the operation. Robotic technology offers superior precision and enables the surgeon to perform a complex reconstruction.

Benefits of Robotic Pyeloplasty

Robotic-assisted pyeloplasty benefits include 

• its precision, 
• shorter operating time and hospital stay, 
• smaller incisions with minimal scar formation, and 
• faster recovery and early return to your daily activities. 

How is Robotic Pyeloplasty Performed

During the procedure, you will lie on your side. 

• Three to four small skin incisions are made on the side of the affected kidney. 
• A laparoscope (long lighted fibre-optic tube with a camera) and surgical instruments held by robotic arms are inserted. 
• A 3D imaging system provides an enlarged and clear vision of the operating site on a monitor.
• The arms of the robot are controlled by Dr Hadley who sits remote from you, at a console. 
• Movements made by Dr Hadley are translated into movements by the robotic arms as the surgery is performed. This improves manoeuvrability and precision.

As with any surgery, robotic pyeloplasty may be associated with complications such as bleeding and infection.