Name of the Procedure:

Pyeloplasty (Foley Y-pyeloplasty), also known as plastic operation on renal pelvis, with or without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting, complicated by congenital kidney abnormality, secondary pyeloplasty, or a solitary kidney.

Summary

Pyeloplasty is a surgical procedure aimed at reconstructing or reshaping the renal pelvis, which is part of the kidney where urine collects before moving to the ureter. This surgery can be complicated by congenital abnormalities, prior surgeries, or the presence of a single kidney.

Purpose

The procedure is intended to correct obstructions or narrowing in the renal pelvis, improving urine flow from the kidney to the bladder. The goals are to relieve pain, prevent kidney damage, and improve kidney function.

Indications

• Symptoms of urinary obstruction such as flank pain, recurrent urinary tract infections (UTIs), or hematuria (blood in urine).
• Diagnosed conditions like ureteropelvic junction (UPJ) obstruction.
• Congenital abnormalities of the kidney or ureter.
• Failure of previous pyeloplasty (secondary pyeloplasty).
• The presence of a solitary kidney that requires maintaining optimal function.

Preparation

• Patients may need to fast for several hours before the procedure.
• Medications may need to be adjusted or discontinued based on the surgeon's advice.
• Preoperative diagnostic tests, including imaging studies like ultrasound, CT scan, or MAG3 renal scan, to assess kidney function and anatomy.

Procedure Description

1. General anesthesia is administered.
2. An incision is made in the flank or abdominal region to access the kidney.
3. The renal pelvis and any involved ureter segments are exposed.
4. The narrowed or obstructed portion is excised.
5. The remaining healthy sections are sutured together (Foley Y-pyeloplasty).
6. Optional procedures include nephropexy (securing kidney position), nephrostomy (placing a tube for urine drainage), pyelostomy (creating an opening in the renal pelvis), or ureteral splinting (using a stent).
7. Incisions are closed and a dressing is applied.

Duration

The procedure typically takes between 2 to 3 hours.

Setting

The procedure is usually performed in a hospital's surgical suite.

Personnel

The surgical team comprises a urologist or pediatric surgeon, an anesthesiologist, and surgical nurses.

Risks and Complications

• Risks include bleeding, infection, injury to surrounding organs, and complications from anesthesia.
• Rare complications may involve persistent obstruction, urine leakage, or reduced kidney function.

Benefits

The expected benefits include improved urine flow, relief from pain and recurrent infections, and protection of kidney function. Benefits are often realized soon after recovery from surgery.

Recovery

• Patients may stay in the hospital for a few days.
• Pain management will be provided, often including pain medications.
• A temporary stent or nephrostomy tube may remain in place for a few weeks.
• Physical activity may be limited initially, with gradual resumption based on the doctor's advice.
• Follow-up appointments are essential to monitor recovery and kidney function.

Alternatives

• Observation and regular monitoring for less severe cases.
• Minimally invasive endoscopic procedures like balloon dilation or stent placement.
• Laparoscopic pyeloplasty as a less invasive surgical alternative.

Patient Experience

Patients might experience some discomfort and pain post-surgery, which is managed with medications. There will be incisional care instructions and activity restrictions during recovery. Long-term follow-up is necessary to ensure the success of the procedure and kidney health.