Laparoscopic / Open PUJ repair

Pelvi-Ureteric Junction Obstruction Repair

Product Summary: AMA rates

Dismembered Pyeloplasty

Item Number: 36564, 105

A congenital or acquired narrowing in the ureteric pelvis junction. This narrowing is excised with a reconnection. There are several techniques described in repairing this: I prefer the Dismembered Pyeloplasty

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?

    • Techniques:
      • Laparoscopic Pyeloplasty.
      • Dismembered.
      • Foley’s Y-V Pyeloplsaty.
      • 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 laparoscopic procedure. The endoscopic procedure is reserved as a second line in my practice.

  • Laparoscopic ports are placed, 1 for camera and 1-2 as working ports.
  • 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 hesitate to ask Jo if you have any queries.
  • 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 longterm antibiotics.

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Robotic Laparoscopic PUJ repair