Laparoscopic Pyeloplasty and PUJ Obstruction
This is a keyhole operation to correct an obstruction in a blocked kidney.
1. Traditional large incision for kidney surgery
2. Open kidney surgery incision
3. da Vinci surgery incisions – compare to open surgery
At the junction of the renal pelvis (where urine is collected after being produced by the kidney) and the ureter (the connecting tube between kidney and bladder) there can be a blockage. This is called a PUJ (pelviureteric junction) obstruction. In the majority of cases this is a congenital (people are born with this problem present) narrowing. A significant proportion of people affected with the condition will also have additional blood vessels to the lower part of the kidney which can kink the PUJ resulting in a blockage.
Although many cases are detected in young children, many do not cause problems until years later in adulthood. Most commonly pain is felt in the affected kidney at times when large volumes of fluids are consumed. This increase in fluid intake results in more urine being produced with the net effect of dilation of the system above the blockage which causes pain.
Traditionally this problem has been corrected with an open operation. The results for this operation are excellent but the down side is the problem of a large incision which can cause significant pain, slow recovery and be cosmetically unappealing. An example of a traditional incision is demonstrated.
Over the years attempts have been made to treat this condition using endoscopic techniques (operations performed internally form the bladder without the need for any skin incisions). The obvious advantage is that there are no incisions. However, the disadvantage is, as the surgical literature consistently tells us, that the success rates from these treatments is around 15-20% less than treatments where the blockage is removed and the PUJ reconstructed.
Laparoscopic pyeloplasty (keyhole repair of the blockage) has the advantage of formally reconstructing the PUJ combined with the avoidance of a large incision and the problems that go with it. Laparoscopic (keyhole) pyeloplasty is performed while under general anaesthetic (patient is asleep). Four small incisions (cuts in the skin) are made and ports or tubes are then placed in these holes. Specialized instruments and telescopic cameras are then used to remove the narrowed segment and to reconstruct the system.
At the end of the operation a stent (small plastic tube) is left internally. The tube passes from the kidney to the bladder and is removed a few weeks after the operations once everything has settled down. The purpose of the stent is to allow the system to remain at low pressure and to encourage the new join to knit together and heal.