Pyeloplasty

What is pyeloplasty?

Pyeloplasty is surgery to correct a ureteropelvic junction obstruction. This is when pee (urine) can't travel from your kidney to your bladder as it should due to a blockage on its way down. A surgeon cuts out the blockage to allow pee to flow to your bladder instead of backing up in your kidney.

Pee normally collects in a funnel-shaped part of your kidney called the renal pelvis. It then flows down through a tube called a ureter to reach your bladder. The point where your kidney’s renal pelvis and ureter meet is known as the ureteropelvic junction (UPJ). Obstruction in this area can lead to complications, such as pain, infection and kidney damage. Pyeloplasty is one way healthcare providers manage the problem.

Who needs pyeloplasty?

About 1 in 1,500 people are born with a UPJ obstruction. If your child was born with a UPJ obstruction, they might need a pyeloplasty if their condition doesn’t improve within 18 months.

Older children, teenagers and adults can also develop a UPJ obstruction. You may need a pyeloplasty if your kidney is blocked, keeping it from functioning properly and causing pee to back up, causing pain or infections. Your healthcare provider may wonder if you have a UPJ obstruction if they see hydronephrosis (swelling of your kidney) on ultrasounds, CT scans or other imaging.

Is pyeloplasty a major surgery?

Pyeloplasty is usually a minimally invasive procedure. Surgeons can perform it:

• Laparoscopically, with small cuts (incisions) in your skin.
• Endoscopically, through your urethra (the tube that drains your pee to the outside of your body).
• With open surgery, which requires a larger incision through your skin and tissues near your kidney.

How do I prepare for a pyeloplasty?

Your provider will give you instructions on how to prepare for a pyeloplasty. Following their directions closely can reduce your risk of complications. Before a pyeloplasty, your provider may ask you to:

• Not eat anything for eight hours before the procedure (fast).
• Stop taking medications before the procedure or take them with just a sip of water. Don’t stop taking medications unless your provider tells you to.
• Make arrangements for someone to drive you home after your procedure (you might need to stay at least one night in the hospital).

How does pyeloplasty surgery work?

To perform a pyeloplasty, a provider will:

1. Give you general anesthesia. You’ll be asleep for the procedure and won’t feel pain.
2. Make one or more incisions on your stomach on the side of your affected kidney.
3. Remove the narrowed or blocked part of your ureter.
4. Reattach your ureter to your kidney’s renal pelvis.
5. Often, they’ll place a stent (small tube) inside or outside where the surgery is done to drain pee temporarily. They’ll remove the stent after your kidney heals.
6. Close the incision(s).

How long does this procedure take?

Pyeloplasty usually takes two to three hours.

What happens after a pyeloplasty?

You may stay in the hospital for a day or two after surgery. While in the hospital:

• You’ll be able to eat and drink normally after the operation.
• You’ll be able to get up and move around after surgery, but follow your provider’s instructions on how active you should be.
• A provider may give you antibiotics to prevent infection.
• You may have a urinary drain (Foley catheter) to remove pee from your body. A provider will remove it when you go home.
• You may have some pain from swelling in your ureter or have bladder spasms for a few days after surgery. Your healthcare providers will give you pain medication either orally (by mouth), through your IV or with an injection.

What are the benefits of pyeloplasty?

Benefits of pyeloplasty include:

• Pain relief.
• Improved kidney function and urine drainage.
• Reduction in kidney swelling (hydronephrosis).

What are the risks or complications of a pyeloplasty?

As with any surgery, pyeloplasty comes with risks. These include:

• Reactions to the anesthesia.
• Bleeding with the need for a blood transfusion.
• Damage to blood vessels or nearby organs (like your bladder or intestines).
• Scarring.
• Infection.
• Hernia (when part of an organ sticks out through your muscle wall).
• Blood clots.
• Need for additional surgery if the obstruction returns due to scarring.
• Pee leaking where your kidney joins your ureter.

How long does it take to recover from pyeloplasty surgery?

It can take a week or two to recover from a pyeloplasty. You might have pain when you pee or blood in your pee for about a week or until your provider removes the stent. You can usually return to your typical activities three to four weeks after the procedure.

You’ll have follow-up appointments with your provider to:

• Remove the stent. If the stent is outside your body, a provider will remove the stent by cutting stitches on your skin and pulling the stent out. You don’t need pain medications for this. If the stent is inside your body, you’ll have another procedure to take it out. You’ll be asleep for the procedure and won’t feel pain.
• Get an ultrasound to check for kidney swelling.

How do I take care of myself after a pyeloplasty?

While you recover, you might want to have a caregiver to help you at least some of the time. Your provider will give you instructions on how to best take care of yourself. They might recommend:

• Drinking plenty of fluids.
• Keeping the dressings (bandages) on for a certain amount of time (typically 24 to 48 hours).
• Taking showers. Avoid baths, which can cause an infection.
• Taking pain medications, antibiotics and any other prescriptions as directed.
• Avoiding strenuous activity or lifting heavy objects for four to six weeks.

What is the success rate of pyeloplasty?

Pyeloplasty is effective for about 95% of adults and kids with UPJ obstruction. This means more than 9 out of 10 people had symptom improvement and their pee was able to flow safely from their kidney to their ureter after surgery.

When should I call my healthcare provider?

Be sure to go to all of your scheduled follow-up appointments. Contact your surgeon or other healthcare provider earlier if you or your child experience any of the following:

• Nausea or vomiting.
• Signs of infection such as a fever, warm skin around the incision, redness around the incision, pus or drainage.
• Severe pain that pain medications don’t relieve.
• Increased swelling around the incisions.
• Severe bleeding (thick and bright red with clots) in your pee.
• Chest pain, shortness of breath or passing out.

Does hydronephrosis go away after pyeloplasty?

Whether or not hydronephrosis resolves after pyeloplasty is unpredictable. Most people have less swelling in their kidney within a year or two of the procedure, but it may never go away completely.