What is a Pyeloplasty?
Pyeloplasty is an operation to repair a blockage of the ureter at the point where it exits the kidney. The blockage may be causing you pain, infections, affecting the function of the kidney, or causing other problems such as kidney stones. Pyeloplasty can be performed using either an open surgical approach or ‘keyhole’ surgery. Where possible, Dr Nathan prefers to use a keyhole approach, but in some complex cases an open approach may be necessary.
How is the operation performed?
Open pyeloplasty is performed under general anaesthetic. A 10-15cm incision is made in the side of the abdomen
The damaged or scarred area of the ureter is excised, and the ureter is re-joined to the drainage system of the kidney using fine sutures. A ureteric stent is always placed to keep the join open during the healing process and is usually removed 3-4 weeks after the surgery.
Also, a urinary catheter is always inserted and stays in place until you are mobile after the operation - usually 1-2 days.
Operative time depends on the complexity of the operation but typically is about 2-3 hours.
What are the alternatives?
- Observation if you are not experiencing any symptoms and the blockage is not affecting the kidney function.
- The narrowing in the ureter is incised but not removed – endopyelotomy.
- Removal or the kidney if it’s function is very poor.
- Stent, which will require regular changes – this is only considered if you are not fit for a major procedure.
Potential side effects and complications
All procedures have the potential for side effects. Although these complications are well recognised, the majority of patients do not have problems after a procedure.
Risks of the anaesthetic need to be discussed with the anaesthetist who will be looking after you during the operation, and who will visit you beforehand.
There are specific risks with this surgical procedure, and these will be discussed with you before your procedure. As a guide to complement that one-on-one discussion with your surgeon, these include:
- Stent symptoms
- Bulging of the wound due to damage to the nerves in the abdominal wall muscles.
- Temporary abdominal bloating.
- Persistent drainage of urine from the repair. This may require a longer period with the drain in place.
- Infection, pain or hernia requiring further treatment.
- 1 in 10 patients can get recurrence of the blockage after pyeloplasty and may need more surgery.
- Bleeding requiring further surgery or blood transfusion.
- Entry into the lung cavity requiring insertion of temporary drainage tube
- Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, deep vein thrombosis pulmonary embolus, stroke, heart attack and death).
- Injury to organs nearby – blood vessels, spleen, liver, lung, pancreas and bowel, requiring more extensive surgery. Very occasionally such injury is not recognised at the time of surgery, and is picked up in the days following your operation.
- Need to remove the kidney at a later stage because of damage caused by recurrent obstruction.
- Infection, pain or hernia of incision needing further treatment.
What should I expect when I get home?
It will be at least 14 days before healing of the wound occurs and it may take up to six weeks before you fully recover from the surgery. You may return to work when you are comfortable enough and your surgeon or GP is satisfied with your progress.
It is advisable that you continue to wear your elasticated stockings for 14 days after your discharge from hospital. Many patients have persistent twinges of discomfort in the loin wound, which can go on for several months. After surgery through the loin, the wall of the abdomen around the scar will bulge due to nerve damage. This is not a hernia but can be helped by strengthening up the muscles by exercises.
Some patients may experience irritation from the ureteric stent until it is removed. The ureteric stent will normally be removed 3-4 weeks after surgery in a quick minor procedure under local anaesthesia or sedation.
This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional.
Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.