Urine is transported from the kidney via the ureter to the bladder. The PUJ is the join between the kidney and the ureter. Occasionally the PUJ becomes narrow causing a blockage in the flow of urine from the kidney to the ureter. This can result in deterioration in kidney function, pain or infection.

Mr Thyer has recommended laparoscopic pyeloplasty to fix the narrowing in the PUJ.

Pre operation

Ten days prior to the procedure you should:

  • Have your blood and urine test
  • Notify Mr Thyer’s rooms if you are taking any blood thinning medication
The procedure

On arrival at hospital you will be prepared for theatre by nursing staff. Mr Thyer will see you just prior to being taken into the operating theatre. You will require a general anaesthetic of approximately 1.5 hours. Mr Thyer will make a series of 3-4 small incisions in the abdomen to allow the passage of the laparoscopic instruments. The PUJ will be dissected free from the surrounding structures, the narrowed section removed then the ureter will be sutured back on to the renal pelvis so that the narrowing is no longer present. The PUJ may be sent to a pathologist for microscopic examination (you may incur a pathologist fee). A stent will be left in place within the ureter to act as a splint whilst the new PUJ heals. After the operation a small drain will be left in the abdomen and a catheter in the bladder. Most people are in hospital 1-2 nights then discharged home after Mr Thyer’s review.

Nephro-uretectomy: open surgical incision vs laparoscopic incision

The narrow UPJ is cut out or cut open and a wider connection is constructed. A temporary stent or nephrostomy tube may be placed.

Risks
  • Bleeding. Bleeding from the operation site is very rare but if occurs may necessitate a return to theatre.
  • Infection. Wound infection is rare but may require a course of oral antibiotics to correct.
  • Conversion to open pyeloplasty. Very occasionally a PUJ is more difficult to dissect free than anticipated using the laparoscopic technique and conversion to open approach is required.
  • Injury to surrounding structures. The bowel, liver, spleen, adrenal, pancreas and large blood vessels are close to the kidney and may require repair if injured during the dissection.
  • Failure of the procedure. The success rate for laparoscopic pyeloplasty is 95%. This means the 1 in 20 people undergoing this procedure will have a recurrence of the PUJ obstruction and may need a further procedure.
  • Hernia. Very occasionally a hernia can develop at one of the laparoscopic port sites which requires correction with a general surgeon.
  • There are risks with any general anaesthetic which are very rare including blood clots, heart or lung problems and adverse drug reactions. The anaesthetist will discuss these with you at the time of the procedure.
Follow up
  • Mr Thyer’s rooms will contact you to arrange follow up to perform flexible cystoscopy and stent removal (Link to flexible cystoscopy) and check pathology 6 weeks following the operation.
  • You should take laxatives, wear compression stockings, drink plenty of water and avoid heavy lifting for 2 weeks following the procedure. You should not drive a motor vehicle for 2 weeks after the operation.
When to contact Mr Thyer

Following the procedure, you should contact Mr Thyer if you:

  • Have a fever over 38 Degrees
  • Are unable to pass urine
  • Have not received a follow up appointment
  • You can contact Mr Thyer via his rooms during working hours or after hours via the after hours nurse at Hollywood Hospital on (08) 9346 6000.


Download   Pyeloplasty for PUJ obstruction    by the Canadian Urological Association

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