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Laparoscopic Pyeloplasty for PUJ Obstruction
Urology / Jun 21st, 2016 9:16 am     A+ | a-
Laparoscopic pyeloplasty offers patients a safe and effective way to perform reconstructive surgery shrinkage or scarring where the ureter (the tube that drains the kidney to the bladder) connects the kidney through a minimally invasive procedure. 

It is used to correct a blockage or narrowing of the ureter as it leaves the kidney. This irregularity is referred to hitch of the ureteropelvic junction (UPJ), resulting in a weak and slow drain urine from the kidneys. UPJ obstruction can potentially cause pain in the abdomen and hip, stones, infections, high blood pressure and renal function impairment. Compared to conventional open surgical technique, laparoscopic pyeloplasty resulted in significantly fewer postoperative pain, short hospital stay, faster recovery to work and daily activities, favorable cosmetic result, and is identical to that of the open.
Laparoscopic pyeloplasty was performed under general anesthesia. The typical length of work is 3-4 hours. The surgery is performed for 3 small incisions (1 cm) in the stomach. The telescope and small instruments are inserted into the abdomen through incisions that allow the surgeon to repair the blockage / narrowing without having to get their hands on the stomach. 

A small plastic tube (called ureteral stent) remains in the urethra at the end of the meet pyeloplasty repair and help drain the kidney. This stent remains in place for four weeks, and usually removed in the doctor's office. Small drainage also allowed to leave his side for discharging liquid to repair the kidney and pyeloplasty.

Potential Risks and Complications

Although this procedure has proven to be very safe, as with any surgery, the possible risks and complications. Safety Speed and similar complications compared with open surgery. Potential risks include:

Bleeding: Blood loss during this process is generally smaller (less than 100 cc) and rarely require blood transfusions. If you are still interested in autologous blood transfusion (donating their blood) before surgery, your surgeon should be aware of. 

Infection: Most patients are cured by broad-spectrum antibiotics intravenously prior to surgery to reduce the risk of infection happens after surgery. If signs or symptoms of infection after surgery (fever, discharge from the incision, the incidence of urinary discomfort, pain or May you be concerned) please contact us at once.

Hernia: hernia at the incision sites rarely happens because all incisions closed lock around the end of the operation.

Tissue / Organ Injury: Although rarely, injury to tissues and organs, including the intestine, vascular structures, spleen, liver, pancreas and gall bladder may require new surrounds operation. Injury may occur in the nerves or muscles that  related to positioning.

Conversion to open surgery: Surgical processes may require conversion to the standard open operation if extreme difficulty is encountered during the laparoscopic procedure. This can lead to greater and perhaps a longer period of recovery standard open cut. Lack of correction to UPJ obstruction: about 3% of patients undergoing this operation will have a lasting blockade due to recurrent healing. If this happens, additional surgery May be required.

What to expect after surgery?
After the surgery operation, the patient will be moved to the recovery room and was taken to his hospital room, after fully awake and your vital signs are stable.

Hospital stays: Length of stay in the hospital for most patients is about 1-2 days.

Diet: Most patients are able to tolerate ice chips and sips of liquids the day after surgery and regular food the next day. Once the normal diet, pain medications may be administered orally, but not by injection or intravenously.

Pain After Operation: Pain medication can be controlled and delivered to the patient through the pump Patient-Controlled
Analgesia (PCA) or intravenous (pain injection), which carried out by a nurse. You may feel pain in the shoulder mild transient (1-2 days) compared to the carbon dioxide gas used to inflate the abdomen during laparoscopic surgery. Nausea may experience nausea or pain medication related to anesthesia. Medications are available to treat frequent nausea.
Urinary Catheter: You can expect to have a urinary catheter to empty the patient’s bladder for about 2 days after surgery. It is not uncommon to have the blood tinged urine for a few days after surgery.

Drain: You will drain out of a small incision in your side. This drain is placed on the surgical site around the operating room to prevent blood and the establishment of fluid around the kidney and Pyeloplasty repair. The drainage usually appears tinged with blood. It is generally removed the day the urinary catheter is removed. If the high volume of drainage persists, you can go home with the drain and removed in your doctor's office. Fatigue is common and should subside within a few weeks after surgery.

Incentive spirometry: You will be expected to do some simple breathing exercises to help prevent respiratory infections using an incentive spirometry device (such exercises will be explained during your stay in hospital). Coughing together with deep breathing is a vital section of the recovery and helps prevent pneumonia and other pulmonary complications.

Ambulation: The day after surgery, it is very important to get out of bed and start walking under the supervision of a caregiver or a member of the family to help avoid blood clots after forming in your legs. You can expect to have (sequential compression devices) SCD with low white tight to prevent blood clots from forming in your legs.
Constipation / Cramps gas: You may experience sluggish bowels for several days after surgery as a result of anesthesia. Suppositories and stool softeners are usually given to help this problem. Take a teaspoon of mineral oil per day at home will also help prevent constipation. Narcotic analgesics may also cause constipation and therefore patients are encouraged to end any narcotic drug against pain after surgery earlier tolerance.

What to expect after discharge from the hospital?

Pain control: Patient is expected to have some pains that may require medication for pain for a week after the release and Tylenol should be sufficient to control your pain.
Showering: You can take a shower after returning from the hospital. Patient wound spots can get soaked, but must be amplified dry immediately afterward bathing. Hot tubs are not recommended in the first 2 weeks after surgery because it will soak your incisions and increase the risk of infection. You will have adhesive strips around your incisions. They will fall in about 5-7 days on their own. Sutures under the skin dissolve in 4-6 weeks.
Activity: Take walks are recommended. Prolonged sitting or lying in bed should be avoided. Climbing stairs is possible, but must be taken slowly. Driving should be avoided for at least 1-2 weeks after surgery. Absolutely no heavy lifting (over 20 pounds) or exercise (jogging, swimming, treadmill, bike) until your doctor's instructions. Most patients return to full activity on an average of 3 weeks after surgery. You can expect to return to work in about 2-4 weeks.
Follow-up: The stent remains in place for about a month and then be removed in the doctor's office through a cystoscope (a small telescoped transmitted ureter to retrieve the stent). It is not uncommon to feel a slight amount of fullness flank and emergency vacuum, which is caused by the stent. These symptoms often improve over time.
Dr. Helena
Apr 26th, 2020 2:21 pm
Thank you, it's very clear, very useful and realistic. Thanks for posting of Laparoscopic Pyeloplasty for PUJ Obstruction video.
May 18th, 2020 10:09 am
Thank you so much for explaining this concept so well! It really simplifies it and makes it actually really easy to understand! Thanks for sharing this video of Laparoscopic Laparoscopic Pyeloplasty for PUJ Obstruction.
Dr. Sangeetha
May 22nd, 2020 3:15 pm
Thank you very much sir for uploading.Laparoscopic Pyeloplasty for PUJ Obstruction. It was very interesting and useful teaching video for doctor and patient's. Thanks for sharing!
Dr. Geethika Bansal
Jun 12th, 2020 8:00 am
Thanks for the great video of Laparoscopic Pyeloplasty for PUJ Obstruction. I am just getting started and this really fires me up to go the distance.
Dr. Salah Hussain Al-Jabadi
Jun 17th, 2020 5:05 pm
Prof Dr. Mishra is the man is truly amazing he made boring topics into interesting ,,, my college professors only hold degrees but he holds degrees with knowledge, What an amazing teacher. God Blessed you.
Dr Nitish Kumar Yadav
Jun 17th, 2020 5:08 pm
Amazing video demonstration of Laparoscopic Pyeloplasty for PUJ Obstruction i found this topic to difficult for me but now i understood whole concept and is taught in very simplified manner. Thank you sir you are really Awesome.
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