Name of the Procedure:

Ureteropyelostomy (Anastomosis of Ureter and Renal Pelvis)

Summary

Ureteropyelostomy is a surgical procedure to reconnect the ureter, the tube that carries urine from the kidney to the bladder, to the renal pelvis, the part of the kidney that collects urine before it moves to the ureter. This procedure helps to correct blockages or injuries in the urinary tract.

Purpose

This procedure is used to treat blockages in the ureter or renal pelvis, which can cause pain, infections, or kidney damage. The goal is to restore normal urine flow from the kidney to the bladder, thus improving kidney function and relieving symptoms.

Indications

• Severe pain in the side or back due to ureteral blockage
• Recurring urinary tract infections
• Hydronephrosis (swelling of the kidney due to urine buildup)
• Ureteral or renal pelvic injuries
• Congenital abnormalities affecting the ureter or renal pelvis

Preparation

• Fasting for 6-8 hours before the procedure
• Stopping certain medications, as instructed by the healthcare provider
• Undergoing imaging tests such as CT scans or ultrasounds to assess the urinary tract
• Completing routine blood work and urinalysis

Procedure Description

1. Anesthesia: General anesthesia is administered to put the patient to sleep.
2. Incision: An incision is made in the patient's side or back to access the kidney and ureter.
3. Disconnection: The blocked or damaged section of the ureter is removed.
4. Reconnection: The healthy end of the ureter is sutured to the renal pelvis to restore urine flow.
5. Closure: The incision is closed with sutures or staples.
6. Drain Placement: A drain may be placed to remove excess fluid or blood from the surgical area.
7. Imaging: Intraoperative imaging such as fluoroscopy may be used to ensure proper placement and function.

Duration

The procedure typically takes 2-4 hours.

Setting

Ureteropyelostomy is performed in a hospital setting, often in an operating room.

Personnel

• Urologic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians
• Radiologic technologists (if intraoperative imaging is required)

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clots
• Injury to surrounding organs or tissues
• Urine leakage from the anastomosis site
• Scar tissue formation leading to recurrent blockage
• Need for additional surgery
• Anesthesia-related complications

Benefits

• Relief from pain and discomfort
• Prevention of recurrent infections
• Improved kidney function
• Restoration of normal urine flow
• Prevention of kidney damage

Recovery

• Hospital stay of 3-7 days post-surgery
• Pain management with medications
• Instructions to avoid heavy lifting or strenuous activities for 4-6 weeks
• Possible temporary placement of a stent to ensure urine flow
• Follow-up appointments to monitor healing and kidney function
• Gradual return to normal activities as approved by the healthcare provider

Alternatives

• Endoscopic stent placement: less invasive but may not be suitable for all blockages
• Nephrostomy: temporary drainage of urine from the kidney
• Ureteral reconstruction: different surgical techniques depending on the location and extent of the blockage Comparison: Ureteropyelostomy offers a more permanent solution but is more invasive than stenting or drainage procedures.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Postoperatively, the patient may experience discomfort at the incision site managed with pain relief medications. Patients might have a catheter to help with urination and should follow all post-surgical care instructions to ensure a smooth recovery. It is normal to feel some soreness and fatigue during the initial recovery period, but these symptoms should gradually improve.