Pyeloplasty Bilateral

Pyeloplasty bilateral surgery

Bilateral pyeloplasty is a medical operation that involves surgery used to correct the obstruction in the ureteropelvic junction (UPJ) of both kidneys. The procedure is done to remove the blockage and re-form the ureter to make both kidneys flow the urine into the bladder properly. This defect is not as prevalent as unilateral UPJ obstruction, it can develop in children or adults.

What Is Bilateral Pyeloplasty?

Bilateral pyeloplasty is defined as the correction of UPJ obstruction in both sides. It can be performed:

• During the same session (single-stage).
• One side at time (staged surgery) based on the functionality of the kidneys and the preference of the surgeon.

Bilateral Pyeloplasty Indications

Bilateral pyeloplasty may be advised by a doctor when both kidneys exhibit the following:

• Extreme hydronephrosis (swelling).
• Recurrent UTIs
• Abdominal pain on both sides of the flank.
• Declining renal function
• Obstruction, congenital (common in babies/young children)
• Obstruction due to:
• Aberrant blood vessel
• Narrow UPJ segment
• Scar tissue
• Kidney stones

Types of Bilateral Pyeloplasty

Laparoscopic Bilateral Pyeloplasty

• Minimally invasive
• 3–4 small incisions per side
• Faster recovery
• Less pain and blood loss

Robotic Bilateral Pyeloplasty

• Most accurate technique, high success.
• Surgeon uses robotic arms
• Complex or pediatric cases

Open Bilateral Pyeloplasty

• Larger incision
• Applied in the cases of the existing surgeries, anatomical disorders, or complications.

Advantages of bilateral Pyeloplasty

• Re-establishes urinary discharge on either side.
• Prevents kidney damage
• Heals common pain or UTIs.
• Enhances the bilateral renal functioning.
• Wide Success rate (>95% in robotic/laparoscopic)

Bilateral pyeloplasty procedure

Bilateral pyeloplasty implies the repair of ureteropelvic junction (UPJ) obstruction in both kidneys. The procedure is possible laparoscopically, robotically or open surgery.

Preoperative Preparation

• Evaluation of patient by means of ultrasound, CT scan, renogram, blood tests.
• Starving 6 hours prior to surgery.
• The whole process is done under general anaesthesia.

Positioning and Port Placement

Laparoscopic/Robotic

• Patient is put in a lateral or supine position in a modified position.

Minor incisions (5-10 mm) are made to insert:

• Camera port
• Working ports
• Assistant ports
• The bilateral placement of ports is on each side.

Open Surgery

• Abdominal or flank incision is done.
• Surgeon reveals both kidneys individually.

Revealance of the Kidney and UPJ (One Side at a Time)

For each kidney:

• The colon is effectively pushed aside.
• There is identification of the renal pelvis and ureter.
• The blocked UPJ part is positioned.
• Blood vessels traversing the UPJ (where present) are meticulously maintained.

Elimination of the Obstructed Segment

• The constriction or obstruction of the UPJ is excised and trimmed.
• Reconstruction is done by trimming the healthy ureter.

Re-forming UPJ (Anderson -Hynes Dismembered Pyeloplasty)

The surgeon performs:

• Spatulation- Ureter is incised in an oblique way to enlarge the aperture.
• Reattachment- The ureter is connected to the renal pelvis by a broad funnel-like suture.
• This facilitates free and unhindered flow of urine.
• This is done on each side of the kidney, usually the poor one.

Placement of a Double-J Stent

• DJ stent is a kidney to bladder internal insertion.
• Promotes recovery and eliminates stenosis.
• Stent remains as long as 4 weeks to 6 weeks.
• A stent is placed in both sides (and one stent in case of staged surgery).

Leakage Checking and Reconstruction Checking

• The anastomosis (connection between the two is examined) to determine the presence of urine leakage.
• Blood clots are removed and surgical field is sprayed.
• Temporary drain can be installed.

Completing the Procedure

Laparoscopic/Robotic

• Ports removed.
• Minor cuts closed using suture or glue.

Open

• Sutured in large incision in layers.

Duration of Surgery

• Laparoscopic/Robotic: 3–4 hours
• Open: 4–5 hours
• It is also a little longer as both sides are dealt with.

After Surgery

• Hospital stay: 2–5 days
• Start liquids the following day or day after.
• Catheter out after 24 -48 hours.
• Drain removed in 1–3 days
• Stent taken out 4-6 weeks later through a mere endoscopic operation.

Success Rate

• Laparoscopic/Robotic Bilateral Pyeloplasty: >95%.
• Open Surgery: 90–95%

Laparoscopic bilateral pyeloplasty

Laparoscopic bilateral pyeloplasty is a minimally invasive operation that is undertaken to cure ureteropelvic junction (UPJ) obstruction on both kidneys with small keyhole incisions. It has quicker recovery, reduced pain and high success rates (>95%).

Indications of Laparoscopic Bilateral Pyeloplasty 

This procedure is advised in cases where the doctors find that the two kidneys present with:

• Serious bilateral hydronephrosis.
• Flank/abdominal pain recurring.
• Recurrent UTIs
• Reduced or worsening renal function.
• UPJ obstruction in children/adults congenital.

Obstruction due to:

• Crossing vessels
• Narrow ureter
• Scar tissue
• Stones blocking UPJ

Benefits of Laparoscopic Bilateral Pyeloplasty 

• Smaller incisions
• Faster recovery
• Less pain
• Lower blood loss
• Shorter hospital stay
• High success rate (>95%)
• Better cosmetic results
• Minimal scarring

Robotic bilateral pyeloplasty

• Robotic bilateral pyeloplasty is a sophisticated and minimally invasive type of surgery that is conducted through the da Vinci robotic system to treat ureteropelvic junction (UPJ) obstruction in both kidneys.
• It can be visualized, flexible and more precise than laparoscopic or open surgery.
• Success rate: >98%
• Indications: Complex anatomy, children, severe bilateral obstruction.

Why Robotic Pyeloplasty? 

• 3D HD magnified view
• Wristed robotic means (7 degrees of freedom)
• Spositioning superior suturing of fragile kidney ureters.
• More accuracy along transversing ships.
• Reduced leakage and recidivism rates.
• Reduced operation time in centres with experience.

Robotic Bilateral Pyeloplasty Indications

Indicated in case of both kidneys having:

• Significant hydronephrosis
• Recurrent pain on both sides
• Repeat urinary tract infections (UTIs).
• Declining renal function
• Congenital UPJ obstructed (common in children and babies).

Obstruction due to:

• Crossing lower pole vessels
• Scar tissue
• Narrow UPJ segment
• Large renal pelvis
• Stones causing obstruction

Perks of Robotic Bilateral Pyeloplasty

• Maximum accuracy and accuracy.
• Excellent among children and complicated anatomy
• Quickest recovery out of any surgical procedure.
• Minimal blood loss
• Reduced complication and recurrence (12-2) rate.
• Very small scars
• Quick recovery of normal functions.

Factors Affecting Cost of bilateral pyeloplasty India

The following are the key variables that affect cost and their application in instigating both kidneys surgery:

Technology /Surgical Approach

The type of surgery one opts to, open, laparoscopic or robotic has a big impact on the cost. For example:

• Open approach is also less expensive. 
• Laparoscopic is costlier as compared to open. 
• Robotic assistance is the most costly because of equipment, consumables and higher training/ complexity. 
• In bilateral surgery, the situation is more complicated (two sides, longer OR time), and therefore the surgical-approach premium is even more applicable.

Location of hospital / facility / city

• Hospitals within big metro areas (Delhi, Mumbai, Bangalore, Hyderabad) are likely to charge more. 
• Super specialty hospitals are privately owned and are more expensive.
• In bilateral surgery, increased OR time, potentially increased stay, increased resources imply increased facility charges.

Surgeon Experience & Team

• The most experienced surgeons, in particular, those who are proficient in robotics or complex bilateral cases will be higher charged. 
• In bilateral bilateral pyeloplasty, a team that has been trained to carry out bilateral pyeloplasty at the same time may be an extra expense.

Condition / Complexity / Comorbidities of the patient

• In case there are complicated anatomy of one or both kidneys (e.g. crossing vessels, highly impaired functioning, previous surgery, anomalies) then the surgery is more complicated, thus increasing the cost. 
• The bilateral obstruction is inevitably more complicated than the unilateral, and both should be cost-effective.

Preoperative Diagnostics and Investigations

• Great deal of imaging (CT scan, renogram, DTPA, nuclear studies) is costly. 
• In the case of bilateral cases, assessment may need to be more detailed.

Hospitalization and the aftercare

• Room type (this is general ward or personal deluxe) has a cost impact. 
• Length of stay: provided that complications occur, time is increased = increased cost.
• In case of bilateral surgery the hospitalization can be slightly extended and more intensive.

Consumables, Implants & Stents

• The Double-J stents drains, robotic instruments, special sutures are all cost adding. 
• Bilateral surgery can involve two stents, and these cost more in terms of consumables.

Follow-up Costs & Complication Costs

• In case complications (leakage of urine, infection etc) arise the cost will be high.
• In bilateral care, there is a slight risk increase (just by the scale) and therefore budget should be permitted.

Bilateral pyeloplasty recovery time

The bilateral pyeloplasty (two kidneys fixed within the same surgical procedure) has a slightly slow recovery compared to unilateral pyeloplasty since there are two kidneys healing at the same time. But in the laparoscopic/ robotic process, recovery is normally easy and rapid.

Hospital Stay

Robotic / Laparoscopic Bilateral Pyeloplasty

• 2–4 days (adults)
• 3–5 days (children)

Open Bilateral Pyeloplasty

• 4-7 days as per pain, drains and wound healing.

Pain & Mobility Timeline

• Day 1: Sitting, standing, and walking with assistance.
• Day 2–3: Walking independently
• 1 week: Minimal pain, nearly normal movement.
• 2 weeks: A majority of patients go back to work light.
• The fact that both sides work might also cause fatigue to last a bit longer (7-10 days).

Stent Removal

• Internal DJ stents take 4-6 weeks on either side.
• Removed through cystoscopy (5-10 minutes procedure)

Re-entry to normal life processes

Robotic / Laparoscopic

• Office work: 2–3 weeks
• Light household work: 1 week
• Driving: After 10–14 days
• Exercise / Gym: After 4–6 weeks
• Heavy lifting: Do not do during 6 weeks.

Open Surgery

• Office work: 4–6 weeks
• Heavy lifting: 8–10 weeks

Complete Recovery Timeline

Bilateral Pyeloplasty with Robots

• Full recovery: 3–4 weeks

Laparoscopic Pyeloplasty

• Full recovery: 4–5 weeks

Open Bilateral Pyeloplasty

• Full recovery: 6–8 weeks

Follow-Up Schedule

• 1 week: Wound check
• 4–6 weeks: Stent removal
• 6-12 weeks: Renogram / ultrasound to determine the amount of kidney drainage.

Conclusion

Bilateral pyeloplasty is a very successful form of surgery in the treatment of both kidneys ureteropelvic junction (UPJ) obstruction. The surgery, regardless of whether it is done by open, laparoscopic, or robotic, will help normal urine flow, avoid permanent kidney damage, and greatly enhance the quality of life of the patients. The least invasive techniques, particularly robotic and laparoscopic, have a quicker recovery, reduced pain, and better accuracy and are the choice of the day in urology. Bilateral pyeloplasty with early diagnosis, quality surgical intervention, and adequate follow-up, has a high success rate, and with such, long-term renal functioning is guaranteed.

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FAQ

Is bilateral pyeloplasty safe?

• Yes. It is one of the most frequently and safely performed procedures, particularly in the case of laparoscopy or robotics. In established facilities, the success rates are more than 95-98.

Why would we do the surgery on both sides simultaneously?

• In cases of bilateral obstruction in the development of hydronephrosis, bilateral pyeloplasty at a single surgery saves the hospitalization of the patient several times, the recovery process is shortened and the progressive loss of kidney function is prevented.

Will there be stents following surgery?

• Yes. Each ureter has a Double-J (DJ) stent to aid in healing. After 4-6 weeks these are evacuated through a mere process of cystoscopy.

Is it possible to have bilateral pyeloplasty for children?

• Yes. It is typical to infants and children with congenital UPJ obstruction. Robotic and laparoscopic techniques are particularly useful with children as a result of accuracy and quicker healing.

Will I need future surgeries?

• A majority of the patients do not require any additional surgery. The recurrence rates are low (1-3 percent). Follow-up should be regularly done to maintain kidney health in the long run.

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