Pelvi-Ureteric Junction Repair (PUJ) – Robotic Assisted

Why is it done?

• High grade obstruction.
• Causing deterioration of renal function.
• Thinning of renal cortex.
• Chronic pain.
• Chronic infection.
• Recurrent renal calculi.

Causes

• Congenital lack of muscle, or neuro transmission in this area, causing a non-functioning part leading to obstruction.
• Vesico-ureteric reflux, longstanding can also cause this.
• Usually diagnosed in kids.
• Crossing vessel.

How is it done?

Robotic assisted pyeloplasty.

• Types
  • • Dismembered.
    • Foley’s Y-V Pyeloplasty.
    • Culp-Dewierd.
    • Pelvi-calyceal pyeloplasty.
    • Endopyelotomy with laser.
  • Patients will receive a general anaesthesia.
  • Prophylactic antibiotics is given.
  • The correct ureteric system is identified and marked while you are awake.
  • This will be mostly a robotic / laparoscopic procedure.
  • The endoscopic procedure is reserved as a second line in my practice.
  • Laparoscopic ports are placed
  • The affected ureter is exposed, the defect cut out with a re-anastomosis of a spatulated ureter to a trimmed renal pelvis over a ureteric stent.
  • An indwelling catheter is placed. A drain is placed.

What next?

• You may be in hospital for 3 days
• Your drain will be removed when there is no urine draining.
• Your catheter will be removed the following day.
• As soon as you are comfortable with no signs of pain and emptying your bladder sufficiently, you will be discharged
• A ward prescription may be issued on your discharge, for your own collection at any pharmacy.
• A follow-up appointment will be scheduled for 6 weeks to remove your ureteric stent under local anaesthesia with a Flexible Cystoscope.
• A review with a CT IVP will be scheduled 6 weeks after this to check on the end result of the ureter.
• Any pain or signs of fever require an urgent review.
• DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Possible Complications

• Re-stenosis with recurrent obstruction.
• Second procedure.
• With further deterioration of renal function, you may require a nephrectomy where affected kidney contributes < 15-20% of total renal function.
• Urine leak, Urinoma, requiring drainage.
• Infection possible sepsis requiring long-term antibiotics.

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Wes RA reair