Ureteropelvic Junction Obstruction
- Endourological treatment of ureteropelvic junction obstruction
- Antegrade (percutaneous): through a small flank incision a nephroscope (endoscopic instrument which provides visibility into the kidney) is introduced to the renal pelvis above the stricture. An endoscopic knife or a laser device is used to incise the stricture.
- Retrograde (transurethral-ureteroscopic): a ureteroscope is introduced through the urethra, then the bladder and into the ureter and is then advanced to below the stricture on the ipsilateral ureter. Dilation of the narrowed portion is then performed with the laser, balloon or knife.
The main advantage of the endourological management is the association with very low morbidity and the patient returns to normal pre-surgery activity soon after the procedure. Nevertheless, recurrence of the stricture is more common in the comparison to other approaches for treatment of ureteropelvic junction obstruction. The patient leaves the hospital on the same day of the procedure and returns immediately to normal activity.
For the performance of endopyelotomy, a knife is used to open the lumen of the stenosed ureter. The method is extremely effective in the case of strictures associated with fibrosis of ureteropelvic junction (strictures after inflammation, injury, or kidney stones) with 82-86% overall efficiency. However, some of the strictures are expected to recur in the future. Postoperative pain is minimal. The patient leaves on the day of surgery. In the case where percutaneous nephrostomy is needed, the tube is removed after 2 weeks.
- Laparoscopic pyeloplasty
In laparoscopic pyeloplasty, the surgical instruments are inserted into the abdomen through incisions on the abdominal wall. The area of stenosis is removed. The ureter is sutured to the renal pelvis resulting in the creation of a new ureteropelvic junction.
A ureteral catheter is left in the ureter as it facilitates the healing process.
Laparoscopic pyeloplasty is associated with minimal morbidity. The blood loss is negligible and the patient is usually mobilized and eats on the first postoperative day, while the hospital discharge takes place on the second day after the surgery. The ureteral catheter is removed after 3 weeks and the removal process is painless.
- Single-site laparoscopic pyeloplasty
Since the scar of the incision is hidden in the umbilicus postoperatively, the single-site surgery does not leave visible scars (scarless surgery). Although the procedure is technically demanding for the surgeon, the technique is proposed for younger people who want to have the best cosmetic result. The results of this alternative technique is identical to the standard laparoscopic approach.