Laparoscopic pyeloplasty in Iran
Full Laparoscopic pyeloplasty package in Iran | Performed by the best Iranian Urology specialists
GOALS
• Relieving the ureter obstruction and pain
• Providing natural urine flow
• Preventing kidney dysfunction and kidney stones
LAPAROSCOPIC PYELOPLASTY IN IRAN: ALL YOU NEED TO KNOW
In a healthy urinary tract, the urine accumulates in the kidney pelvis and then flows to the bladder through the ureter. The kidney pelvis is shaped like a funnel and is joined to the ureter at its bottom. This area is called the ureteropelvic junction. Ureteropelvic junction obstruction may occur due to congenital defects, scar tissue formation, infections, trauma, the crossing of blood vessels, ureter valves and kinks and in rare cases tumor.
The obstruction causes backflow of the urine to the kidney, which leads to build-up pressure, pain, hematuria, stone formation and over time even kidney dysfunction and loss.
Pyeloplasty is the operation procedure of removing this blockage. In this operation, the scarred tissue is cut and removed. Then the healthy part of the ureter is attached to the pelvis. If the obstruction is because of a crossed blood vessel, the ureter is cut, pulled out and reconnected over the blood vessel.
The surgery can be done in three manners: open surgery in which a large open incision is made under the rib, laparoscopy using small incisions and camera, and robotic using robotic arms to help the surgeon.
Laparoscopic pyeloplasty causes less post-operative pain, more comfortable recovery, earlier return to work, shorter hospital stay, and better cosmetic results compared to open surgery.
The cause of pyeloplasty surgery
Congenital defects are the most common cause of Ureteropelvic junction obstruction. In these cases, the obstruction develops before birth and the ureter is too narrow to let the urine flow out of the pelvis. The condition is diagnosed before birth using ultrasound and is fixed after birth.
In some cases, the ureter seems normal however an external tissue like blood vessels makes pressure on the ureter so blocks the urine flow. Some rare disorder polyps, scars and, tumors can cause this complication.
The pyeloplasty is needed to protect the kidney and improve its function. The operation helps to prevent urinary tract infections and pain. In addition, when the kidney functions properly, the other kidney doesn’t get over-stressed.
Preparations for Laparoscopic pyeloplasty
In the consultation sessions, the surgeon examines you and reviews your medical documents. Here are the steps to consider before the surgery:
• It is strongly recommended to refrain from using blood-thinning drugs such as Advil, Aspirin, and Ibuprofen a week before surgery.
• The evening of the day before your surgery, drink a bottle of magnesium citrate. It is important to not drink and eat anything after midnight.
• 24 hours before your surgery maintain a clear liquid diet. These are considered clear liquids: water, broths with no cream, meat and noodles, juices except orange and tomato juice, and tea and coffee without cream and milk.
Risks of Laparoscopic pyeloplasty
Infection, bleeding, swelling and inflammation, and failure to fix the problem are the risks of any surgery. Pyeloplasty most common specific risks are scar tissue formation at the sutured site (roughly in 3% of patients), which leads to blockage and another surgery and urine leakage during surgery that causes irritation in other areas. If the leakage continues after surgery, another tube is used to help the flow and drainage. The surgery may convert to open surgery if the surgeon faces extreme difficulty in laparoscopic operation. The Hernia is another complication of the surgery. However, since the incision are tiny (keyhole incisions) they will be closed completely and the probability of hernia is very low.
What to expect from a pyeloplasty surgery?
After the surgery, you may experience mild pain at your incision sites that can be managed with intravenous or oral analgesics. Nausea is the side effect of general anesthesia, which is controlled using medications.
A catheter is placed to drain your bladder for a few days after the surgery. When you are comfortable walking, a nurse will remove the catheter.
A clear tube will be placed at your incision site to identify and drain the possible urine leakage and bleeding. The tube exits from the side of your flank. Therefore, it is called a flank drain. The drain will be removed on your discharging day if the drainage is low.
For 4 weeks after the surgery, a ureteral stent will facilitate urine drainage from your kidney to the bladder. The stent is a small, flexible and plastic tube. After this period, your surgeon will remove the stent in the office.
One of the side effects of anesthesia is the sluggishness of the small intestines. Therefore, after the surgery start with liquid and advance to solid foods.
Laparoscopic pyeloplasty FAQs
1. How do you know if children need a pyeloplasty?
The blockage in ureter causes dilation kidney pelvis. This condition is called Hydronephrosis. The surgeon can detect this condition with an ultrasound and a kidney scan.
2. Are any implants used in this procedure?
No. The surgeon does not use any artificial part to correct the issue. In this surgery, the obstructed part is removed and the healthy part of the ureter is attached to the kidney pelvis after repositioning.
3. Where are the incisions made?
There are a few angles for doing the surgery. However, generally, the incision is on your side. The sutures will dissolve over time. If a tube is inserted, the sutures will be removed after about 10 days.
4. How long does the surgery take?
The surgery is performed in 2 to 3 hours.
5. Will there be any problem in urinating after the surgery?
You may feel the urge to urinate frequently because of the bladder catheter and have difficulty urinating the first few times. Putting warm clothing on the skin between genitalia and the anus could help you to feel more comfortable.
6. How is the follow-up process after surgery?
Usually, you will be discharged after 2 to 3 days. If a catheter is used, there will be an appointment for removing it after one week. Otherwise, make an appointment for one month later. One to two months after the surgery an ultrasound will be done to identify any blockage at the surgery site. Your surgeon may recommend a kidney scan to assess the function. It is recommended to have another ultrasound after six to eight months.
7. How is the recovery process?
For the first two weeks after the surgery, walk on level surfaces for 4-6 times a day to prevent thrombosis and pulmonary complications.
You can shower immediately after discharge from the hospital. Just make sure to dry the incision sites with a pad to prevent infection. Taking a bath is discouraged in the first two weeks.
The stitches under the skin will dissolve after 4-6 months. Your surgeon may use glue or strips on the incision sites after suturing them. The glue will fall off on its own and there is no need for removal in the doctor’s office.
Refrain from heavy activities for 4 weeks after the surgery. On average after 3-4 weeks after surgery you can return to work and your daily activities. You can start driving once you gain back full range of motion at your waist and stop taking narcotics for your pain.
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