Name of the Procedure:

Pyeloplasty (Foley Y-pyeloplasty)

Summary

Pyeloplasty is a surgical procedure aimed at correcting a blockage or narrowing where the ureter attaches to the kidney's renal pelvis. The operation reshapes or repositions the ureter and may involve additional procedures such as nephropexy (securing the kidney in place), nephrostomy (inserting a tube to drain the kidney), pyelostomy (creating an opening in the renal pelvis), or ureteral splinting (placing a stent in the ureter).

Purpose

Pyeloplasty is primarily performed to alleviate a condition known as ureteropelvic junction (UPJ) obstruction, where urine flow from the kidney to the bladder is blocked. The expected outcomes of the procedure are improved urine drainage and relief from associated symptoms such as pain, infection, and possible kidney damage.

Indications

• Frequent urinary tract infections
• Flank pain or a palpable mass
• Poor kidney function
• Hydronephrosis (swelling of the kidney due to urine buildup)
• Planning for corrective surgery following diagnosis of UPJ obstruction

Preparation

• Fasting typically required from midnight before the surgery.
• Adjustments to medications as directed by the healthcare provider.
• Preoperative diagnostic tests such as blood tests, urinalysis, ultrasound, or CT scan may be required to assess kidney function and structure.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia to ensure they are asleep and pain-free.
2. Incision: A small incision is made in the patient's side or abdominal area.
3. Expose and Assess: The surgeon gains access to the kidney and ureter, assessing the extent and location of the obstruction.
4. Reconstruction: The narrowed segment of the ureter is removed, and the healthy parts are reshaped and reattached using the Foley Y-pyeloplasty technique.
5. Additional Procedures: If needed, procedures like nephropexy, nephrostomy, pyelostomy, or ureteral splinting are performed.
6. Closure: The incision is closed, and a sterile dressing is applied.

Duration

The surgery typically lasts between 2 to 4 hours, depending on the complexity of the individual case.

Setting

Pyeloplasty is performed in a hospital or a specialized surgical center.

Personnel

• Surgeon (Urologist)
• Anesthesiologist
• Surgical nurses
• Operating room support staff

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs or tissues
• Anastomotic leak (where the reattached ureter joins the renal pelvis)
• Scar tissue formation leading to recurrence of the obstruction
• Anesthesia-related complications

Benefits

• Relief of symptoms such as pain and recurrent infections
• Improved urine drainage
• Prevention of further kidney damage Results are usually apparent within a few weeks to a few months post-surgery.

Recovery

• Hospital stay of 2-3 days post-procedure.
• Pain management with prescribed medications.
• Instructions for wound care and activity restrictions.
• Avoid heavy lifting and strenuous activities for several weeks.
• Follow-up appointments to monitor healing and kidney function, often including imaging tests like ultrasound.

Alternatives

• Endopyelotomy: A less invasive procedure using a scope and laser to cut through the blockage.
• Observation: Monitoring the condition without immediate intervention, often chosen if symptoms are mild.
• Balloon dilation: Attempting to expand the narrowed area using a balloon catheter.

Patient Experience

• Initially, patients may experience discomfort and need pain medication.
• A catheter may be in place to help drain urine.
• Gradual return to normal activities with recovery guidance from the healthcare team.
• Patients often feel significant symptom relief once fully recovered.