Unilateral Pyeloplasty

Pyeloplasty unilateral surgery

Pyeloplasty is a surgical operation conducted to treat a problem known as Ureteropelvic junction (UPJ) blockage, which obstructs the passage of urine between the kidney and the ureter. Unilateral pyeloplasty involves treatment of a single kidney.

It can be done via:

• Open Pyeloplasty
• Laparoscopic Pyeloplasty
• Robot-assisted Pyeloplasty

Unilateral Pyeloplasty Advantages

• Relieves UPJ obstruction
• Avoids frequent pains and infections.
• Saves kidney against permanent damage.
• Enhances kidney drainage and functioning.

Minimally invasive (laparoscopic/robotic) alternative has:

• Less pain
• Smaller incisions
• Shorter hospital stay
• Faster recovery

Unilateral pyeloplasty procedure

Pre-operative Preparation:

• Complete blood tests, urine tests, ultrasound and renal scan (MAG3/DTPA).
• CT urogram if required.
• Avoiding contact with food 6-8 hours prior to surgery.
• General anaesthesia occurs.

Position and Preparation

• Patient lies in lateral flank (lower kidney up).
• Abdomen and flank are wiped and covered.

Placement (Laparoscopic/Robotic) Port/Instruments

• There are 3-4 small keyholes incisions.
• Special instruments and a camera are introduced.
• The CO2 gas fills up the stomach to make it visible.
• (In open operation, one flank incision is done.)

Diagnosis of the UPJ Obstruction

Surgeon locates:

• Smaller ureteropelvic junction.
• Renal pelvis
• Crossing vessels (if present)
• The hampered part is meticulously revealed.

Deconstruction of the Blocked Segment

• The hindered or constricted UPJ is excised.
• In case of compression between crossing vessels of the UPJ, the repair is re-located before the vessels.

Re- UPJ reconstruction (AndersonHynes Dismembered Pyeloplasty)

• The most popular and widespread one.

Steps:

• To enlarge the ureter, it is spatulated (lengthwise opening).
• The renal pelvis becomes trimmed or reformed.
• The ureter is then sewed to the renal pelvis with the intention of producing a smooth, broad junction.
• A careful stitching up will guarantee a waterproof repair.

DJ Stent Insertion

• A stent made of double-J (DJ) is inserted in the ureter.

Role of the stent:

• Maintains urine flow
• Supports healing
• Avoids congestion in the restoration process.

Completion and Closure

• The leaks of the reconstructed UPJ are checked.
• Instruments are removed.
• Small tears are stitched using absorbable sutures.
• A drain can be temporary (different according to surgeon).

Post-operative Care

• Hospital time: 1- 2 days (laparoscopic), 3- 5 days (open).
• The intake begins orally a few hours after surgery.
• Pain management and IV fluids are availed.
• In 24-48 hours (when used) Drain.

Follow-up

• Stent removal: 4-6 weeks post-operation (through cystoscopy).
• Ultrasound: during 6-12 weeks to ensure better drainage.
• Renal scan: possibly after 3 months.

Procedure Duration

• Laparoscopic/Robotic: 1.5 to 3 hours.
• Open: 2.5 to 4 hours

Success Rate

• 90-98, particularly laparoscopic/robotic.

Robotic unilateral pyeloplasty

• Robotic pyeloplasty is a sophisticated minimally invasive procedure that is applied in repairing a ureteropelvic junction (UPJ) obstruction) on one kidney.
• It operates on the da Vinci surgical robot which is very precise and offers a 3D view and wristed instruments that resemble the movements of a surgeon hand.
• It is regarded as the gold standard of pyeloplasty as it has a very high success rate and it recovers quickly.

Indications

Robotic unilateral pyeloplasty is carried out in case of:

• UPJ obstruction (latent congenital or acquired)
• Squeezing ships that lead to compression.
• Flank pain, frequent UTIs, or hydronephrosis.
• Reduced renal functioning in one kidney.

Benefits of Robotic Pyeloplasty

• Highest success rate (95–99%)
• Minimal blood loss
• Extremely precise suturing
• Less pain and scarring
• Faster recovery
• Improved results in multifarious UPJ obstructions or cross vessels.

Open unilateral pyeloplasty surgery

• Unilateral pyeloplasty is an old surgical procedure used to treat the ureteropelvic junction (UPJ) obstruction afflicting one kidney.
• The most popular modern use of the minimally invasive (laparoscopic/robotic) techniques is, however, open pyeloplasty, particularly when there is complex anatomy, severe scarring, or redo procedures.
• Success rate: 90–95%

Open Pyeloplasty indications

Open pyeloplasty can be selected in cases where:

• Severe UPJ obstruction
• Big or multifaceted renal pelvis structure.
• Large scar tissue as a result of her past surgical procedures.
• Unsuccessful laparoscopic/robotic repair.
• Preference of the surgeon in complicated/ pediatric cases.
• Absence of minimal invasive technology.

Factors Affecting Cost of unilateral pyeloplasty India

The important considerations in determining the cost of unilateral pyeloplasty surgery in India are as follows:

Technology and technique of surgery

• In general open surgery is less expensive than laparoscopic surgery or robotic surgery. 
• Costs of laparoscopic approach are greater due to special tools and proficiency. 
• Robotic surgery will be an additional expense because of the robot platform, disposables, extended OR time etc. 

Hospital position and quality

• Metro towns turn out to be more expensive than smaller ones (hospitals in Delhi, Mumbai, Hyderabad, Bangalore). 
• There is hospital accreditation, infrastructure (ICU availability, international patient services), and private vs public which also influences costs. 

Experience and team expertise in surgeon

• Very experienced urologists or those who are reputed may charge high prices. 
• Assistants, anaesthesiologists, and surgical team- this adds to the variability in cost.

Clinical history of patient and complexity of surgery

• In case of complex obstruction, crossing vessels, re-operate, scar tissue, damage of kidney - surgery will be prolonged, complicated - more expensive. 
• The pre-existing diseases or comorbidities could demand extra investigations, pre-op optimisation, and extended stay in the hospital.

Room type and duration of stay at hospital

• Days of stay in the hospital after surgery. Stay can be increased in case of complications.
• Cost depends on room type (general ward vs private room vs deluxe). 

Diagnostics, consumable and post-operative care

• Pre-op diagnostics (renal scan, CT urogram, labs) are not cheap. 
• Expendable supplies: instruments, supplies.
• Post-operative treatment pain treatment, follow-ups and outpatient visits, stent removal.

Unilateral pyeloplasty recovery time

The healing process of unilateral pyeloplasty is dependent on the nature of operation, age and general health of the patient. The recovery timeline is as below.

Hospital Stay

Robotic / Laparoscopic Pyeloplasty

• 1–2 days

Open Pyeloplasty

• 3–5 days
• A little bit longer because of the bigger incision.

Pain & Mobility

• First 2–3 days
• Mild-moderate pain (open surgery more so)
• It encourages walking within 24 hours.

Return to Normal Activities

Laparoscopic / Robotic

• Light activities: 5–7 days
• Work (desk job): 1–2 weeks    
• Heavy activities: 4–6 weeks

Open Surgery

• Light activities: 2 weeks
• Work (desk job): 3–4 weeks
• Heavy lifting: 6–8 weeks

Stent Removal

• DJ stent is kept for 4–6 weeks
• Removed via cystoscopy
• The urinary frequency/urgency might be some during the period of the stent.

Full Healing Time

Laparoscopic / Robotic

• 2–3 weeks for internal healing
• Complete recovery: 4 weeks

Open Surgery

• 4-6 weeks of healing of internal and incision.
• Complete recovery: 6–8 weeks

Follow-Up Tests

• Ultrasound at 6–12 weeks
• At 3 months, renal scan (where necessary) to determine whether the drainage is improving.

Conclusion

Unilateral pyeloplasty is a very effective and dependable surgical intervention of Ureteropelvic junction (UPJ) obstruction in one kidney. Regardless of the method used to carry the procedure open, laparoscopic, or robotic-assisted, the goal of the procedure is to achieve a normal urine flow, alleviate symptoms, and maintain normal renal functionality in the long term. Minimally invasive options provide quicker recovery and the less postoperative pain whereas open surgery is a good alternative when case is complex and also in cases of redo cases. Most patients’ record high success rates of 90-98, proper after operation care, management of stents and follow up imaging at the right time. The initial diagnosis, high level of surgical skills and quality of hospital facilities are influential factors that will guarantee the best recovery and future kidney wellness.

Affordable unilateral pyeloplasty India GetWellGo

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FAQ

Is the surgery painful?

• You are going to be in general anaesthesia and therefore you will not feel the pain. Post-operative pain is mild to moderate and treated with drugs.

Will a stent be used?

• Yes. A Double J (DJ) stent is inserted in the ureter to aid in healing. Removal is normally done after 4-6 weeks using a simple cystoscopy.

Which activities are not to be performed following the surgery?

• Never lift heavy, engage in strenuous activities and hard physical labor within a period of 4-8 weeks depending on the nature of the operation. Walking is encouraged.

Will I have a scar?

• Laparoscopic/Robotic: Minor keyhole wounds.
• Open: A bigger scar of the incision of the flank.

Will kidney functioning be better with pyeloplasty?

• Yes, if performed on time. The operation assists in averting advance damage to the kidneys and can ameliorate functionality as per pre-operative status.

Does pyeloplasty in children cause any harm?

• Yes. It is usually done in adults and children with great long term results.