Laparoscopy, surgical; pyeloplasty
CPT4 code
Name of the Procedure:
Laparoscopy, surgical; pyeloplasty
Common name(s): Laparoscopic Pyeloplasty
Summary
Laparoscopic pyeloplasty is a minimally invasive surgical procedure that involves repairing a blockage or narrowing of the ureter at the point where it joins the kidney. This procedure is performed using small incisions and specialized instruments.
Purpose
Laparoscopic pyeloplasty addresses a condition known as ureteropelvic junction (UPJ) obstruction, which impairs the flow of urine from the kidney to the bladder. The goal is to relieve obstruction, restore normal urine flow, and preserve kidney function.
Indications
- Flank pain or abdominal pain
- Recurrent urinary tract infections
- Kidney stones
- Hydronephrosis (swelling of the kidney due to urine buildup)
- Decreased kidney function shown in diagnostic tests
Preparation
- Fasting for at least 8 hours before the procedure
- Adjustment or discontinuation of certain medications as advised by the doctor
- Preoperative diagnostic tests such as blood tests, urine tests, and imaging studies (e.g., ultrasound, CT scan)
Procedure Description
- Patient is placed under general anesthesia.
- Small incisions are made in the abdomen to insert a laparoscope (a small camera) and other specialized surgical instruments.
- The surgeon visualizes the affected area on a monitor and carefully dissects and removes any obstructive tissues in the ureteropelvic junction.
- The ureter is rejoined to the renal pelvis with fine sutures to create a wide, unobstructed passage.
- A stent (temporary tube) may be placed in the ureter to ensure proper healing and urine flow.
- The instruments are removed, and incisions are closed with sutures or surgical adhesive.
Duration
The procedure typically takes 3 to 4 hours.
Setting
Laparoscopic pyeloplasty is performed in a hospital's operating room.
Personnel
- Urologic surgeon specialized in laparoscopy
- Surgical nurses
- Anesthesiologist
- Surgical technologists
Risks and Complications
- Infection
- Bleeding
- Injury to surrounding organs
- Urine leakage from the repair site
- Formation of scar tissue causing re-obstruction
- Possible need for additional surgeries
Benefits
- Minimally invasive with smaller incisions
- Shorter hospital stay and quicker recovery
- Reduced post-operative pain
- Improved kidney function and relief of symptoms
Recovery
- Hospital stay of 1 to 3 days post-surgery
- Pain management with prescribed medications
- Avoid strenuous activities for 4 to 6 weeks
- Follow-up appointments to monitor healing and stent removal about 4 to 6 weeks post-op
Alternatives
- Open pyeloplasty (more invasive with larger incision)
- Endoscopic (internal) procedure (less commonly used)
- Observation in mild cases with no symptoms
Pros and cons of alternatives:
- Open pyeloplasty: good success rate but longer recovery period and more pain
- Endoscopic procedure: less invasive but higher recurrence rate
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel anything. Post-surgery, patients may experience discomfort or pain at the incision sites, managed effectively with pain medication. Most patients can resume normal activities within a few weeks, although strenuous activities should be avoided during the recovery period.